Provider First Line Business Practice Location Address:
634 S LARCH PL
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
E WENATCHEE
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98802-9255
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
509-679-8960
Provider Business Practice Location Address Fax Number:
509-470-7617
Provider Enumeration Date:
07/15/2013