Provider First Line Business Practice Location Address:
1509 MADISON ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
WENATCHEE
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98801-1731
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
206-383-9164
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
10/10/2012