Provider First Line Business Practice Location Address:
518 N PINE ST
Provider Second Line Business Practice Location Address:
SUITE 102
Provider Business Practice Location Address City Name:
ELLENSBURG
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98926-3196
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
509-933-2838
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
10/11/2006