Provider First Line Business Practice Location Address:
208 S RUBY 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:
98926-3712
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
541-519-2768
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
05/13/2007