Provider First Line Business Practice Location Address:
4031 MANASTASH RD
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:
98926-7829
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
360-473-7516
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
05/28/2015