Provider First Line Business Practice Location Address:
1008 E MOUNTAIN VIEW AVENUE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
ELLENBURG
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98926
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
509-925-4484
Provider Business Practice Location Address Fax Number:
509-925-4483
Provider Enumeration Date:
03/22/2007