Provider First Line Business Practice Location Address:
430 ELVA WAY
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:
98802-5418
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
509-886-9355
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
02/01/2007