Provider First Line Business Practice Location Address:
SOUTH 5 WENATCHEE AVE.
Provider Second Line Business Practice Location Address:
SUITE 336
Provider Business Practice Location Address City Name:
WENATCHEE
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98801
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
509-670-7276
Provider Business Practice Location Address Fax Number:
509-667-9557
Provider Enumeration Date:
02/21/2007