Provider First Line Business Practice Location Address:
306 S MAIN ST
Provider Second Line Business Practice Location Address:
SUITE 1
Provider Business Practice Location Address City Name:
ELLENSBURG
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98926-3608
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
509-925-3160
Provider Business Practice Location Address Fax Number:
509-232-7181
Provider Enumeration Date:
05/04/2016