Provider First Line Business Practice Location Address:
201 S LOCUST ST
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:
98926-9006
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
206-892-8325
Provider Business Practice Location Address Fax Number:
844-848-7543
Provider Enumeration Date:
11/18/2015