Provider First Line Business Practice Location Address:
2133 W WOODIN AVE UNIT 1
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
CHELAN
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98816-9309
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
509-630-1160
Provider Business Practice Location Address Fax Number:
509-508-5234
Provider Enumeration Date:
12/31/2024