Provider First Line Business Practice Location Address:
1011 N ALDER ST
Provider Second Line Business Practice Location Address:
SUTIE1
Provider Business Practice Location Address City Name:
ELLENSBURG
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98926-2699
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
509-962-2570
Provider Business Practice Location Address Fax Number:
509-962-4668
Provider Enumeration Date:
10/14/2011