Provider First Line Business Practice Location Address:
601 N MAIN ST STE 1
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:
98926-6305
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
509-962-9575
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
12/11/2019