Provider First Line Business Practice Location Address:
810 E CAPITOL AVE
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:
98926-3421
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
503-709-4463
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
08/10/2010