Provider First Line Business Practice Location Address:
413 N MAIN ST
Provider Second Line Business Practice Location Address:
STE A
Provider Business Practice Location Address City Name:
ELLENSBURG
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98926-3183
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
509-925-5226
Provider Business Practice Location Address Fax Number:
509-925-5551
Provider Enumeration Date:
01/16/2007