Provider First Line Business Practice Location Address: 
900 EASTMONT AVE
    Provider Second Line Business Practice Location Address: 
    Provider Business Practice Location Address City Name: 
EAST WENATCHEE
    Provider Business Practice Location Address State Name: 
WA
    Provider Business Practice Location Address Postal Code: 
98802-6602
    Provider Business Practice Location Address Country Code: 
US
    Provider Business Practice Location Address Telephone Number: 
509-884-9000
    Provider Business Practice Location Address Fax Number: 
    Provider Enumeration Date: 
09/08/2022