Provider First Line Business Practice Location Address:
119 W 5TH AVE STE 203
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
ELLENSBURG
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98926-3180
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
509-859-6820
Provider Business Practice Location Address Fax Number:
509-416-2033
Provider Enumeration Date:
02/19/2019