Provider First Line Business Practice Location Address:
100 E JACKSON AVE STE 102
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:
98926-3693
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
509-933-8860
Provider Business Practice Location Address Fax Number:
509-933-8870
Provider Enumeration Date:
07/12/2021