Provider First Line Business Practice Location Address:
667 GRANT ROAD
Provider Second Line Business Practice Location Address:
SUITE 3
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
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
509-679-4640
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
12/21/2011