Provider First Line Business Practice Location Address:
521 E MOUNTAIN VIEW 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:
98926-3865
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
509-933-2400
Provider Business Practice Location Address Fax Number:
509-933-4804
Provider Enumeration Date:
09/17/2008