Provider First Line Business Practice Location Address:
1511 E SEATTLE AVE
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:
98926-9448
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
509-507-1179
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
10/24/2012