Provider First Line Business Practice Location Address:
109 E 3RD AVE STE 7
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:
98926-3357
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
509-925-2258
Provider Business Practice Location Address Fax Number:
509-925-2008
Provider Enumeration Date:
10/14/2006