Provider First Line Business Practice Location Address:
717 E 1ST ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
CLE ELUM
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98922-1252
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
509-306-5105
Provider Business Practice Location Address Fax Number:
888-538-7694
Provider Enumeration Date:
08/30/2021