Provider First Line Business Practice Location Address:
203 MISSION STREET
Provider Second Line Business Practice Location Address:
SUITE 112
Provider Business Practice Location Address City Name:
CASHMERE
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98815
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
509-782-8818
Provider Business Practice Location Address Fax Number:
509-782-8919
Provider Enumeration Date:
05/30/2006