Provider First Line Business Practice Location Address:
901 4TH ST SE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
E WENATCHEE
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98802-5408
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
509-860-7976
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
08/15/2012