Provider First Line Business Practice Location Address:
246 DIVISION ST
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:
98826-1426
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
509-293-3441
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
06/26/2026