Provider First Line Business Practice Location Address:
1207 N TANGLEWOOD CT
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:
98926-5185
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
425-772-8266
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
12/02/2014