Provider First Line Business Practice Location Address:
1300 E 3RD 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:
98926-3576
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
509-925-8122
Provider Business Practice Location Address Fax Number:
509-925-8036
Provider Enumeration Date:
11/06/2012