Provider First Line Business Practice Location Address:
1120 GRANT RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
EAST WENATCHEE
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98802-5243
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
509-884-7163
Provider Business Practice Location Address Fax Number:
509-884-2363
Provider Enumeration Date:
08/15/2017