Provider First Line Business Practice Location Address:
10007 MERRY CANYON RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
LEAVENWORTH
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98826-9126
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
509-548-6817
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
10/16/2015