Provider First Line Business Practice Location Address:
1558 N GROVER AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
EAST WENATCHEE
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98802-8346
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
206-453-9853
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
02/14/2012