Provider First Line Business Practice Location Address:
103 E 4TH AVE STE 200
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:
98926-3189
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
509-962-6235
Provider Business Practice Location Address Fax Number:
541-966-9130
Provider Enumeration Date:
02/07/2007