Provider First Line Business Practice Location Address:
2101 N ALDER ST APT 24
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:
98926-2272
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
509-859-3363
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
06/19/2012