Provider First Line Business Practice Location Address:
103 E 4TH AVE STE 205
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:
98926-3189
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
206-225-7263
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
01/31/2014