Provider First Line Business Practice Location Address:
940 HIGHWAY 2
Provider Second Line Business Practice Location Address:
UNIT C
Provider Business Practice Location Address City Name:
LEAVENWORTH
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98826-1479
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
509-699-0214
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
12/19/2012