Provider First Line Business Practice Location Address:
304 GRANT RD
Provider Second Line Business Practice Location Address:
SUITE 2
Provider Business Practice Location Address City Name:
EAST WENATCHEE
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98802-5384
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
509-886-4554
Provider Business Practice Location Address Fax Number:
509-782-9255
Provider Enumeration Date:
01/20/2007