Provider First Line Business Practice Location Address:
7600 MANASTASH 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:
98926-7810
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
509-962-1335
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
04/08/2016