Provider First Line Business Practice Location Address:
115 W 1ST ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
CLE ELUM
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98922-1515
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
509-852-0123
Provider Business Practice Location Address Fax Number:
509-852-4567
Provider Enumeration Date:
03/07/2018