Provider First Line Business Practice Location Address:
11779 US HIGHWAY 2 STE 107
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:
98826-1364
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
509-888-2353
Provider Business Practice Location Address Fax Number:
206-672-5976
Provider Enumeration Date:
09/12/2013