Provider First Line Business Practice Location Address:
507 HOSPITAL WAY
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
BREWSTER
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98812-0507
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
509-689-2517
Provider Business Practice Location Address Fax Number:
509-689-2086
Provider Enumeration Date:
10/31/2006