Provider First Line Business Practice Location Address:
611 S CHESTNUT ST
Provider Second Line Business Practice Location Address:
SUITE C
Provider Business Practice Location Address City Name:
ELLENSBURG
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98926-4815
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
509-925-9355
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
04/02/2007