Provider First Line Business Practice Location Address:
100 E JACKSON 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:
98926-3692
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
509-933-8777
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
08/16/2018