Provider First Line Business Practice Location Address:
4461 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:
98926-6630
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
509-607-0193
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
06/27/2013