Provider First Line Business Practice Location Address:
136 E JOHNSON AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
CHELAN
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98816
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
509-888-5477
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
09/07/2015