Provider First Line Business Practice Location Address:
2681 UMPTANUM RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
ELLENSBURG
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98926-8362
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
509-962-9079
Provider Business Practice Location Address Fax Number:
509-925-2591
Provider Enumeration Date:
09/19/2019