Provider First Line Business Practice Location Address:
1401 EMERSON 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:
98926-8437
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
509-431-8035
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
08/05/2014