Provider First Line Business Practice Location Address:
190 RUSTIC RD
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:
98926-9206
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
509-933-1984
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
12/21/2006