Provider First Line Business Practice Location Address:
209 S RUBY ST
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:
98926-3711
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
509-312-8271
Provider Business Practice Location Address Fax Number:
509-420-9889
Provider Enumeration Date:
06/17/2026