Provider First Line Business Practice Location Address:
116 N OAKES AVE
Provider Second Line Business Practice Location Address:
STE A
Provider Business Practice Location Address City Name:
CLE ELUM
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98922
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
509-240-8676
Provider Business Practice Location Address Fax Number:
844-789-7048
Provider Enumeration Date:
12/05/2007