Provider First Line Business Practice Location Address:
700 E MANITOBA AVE
Provider Second Line Business Practice Location Address:
STE 109
Provider Business Practice Location Address City Name:
ELLENSBURG
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98926-3885
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
509-933-8720
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
08/04/2006