Provider First Line Business Practice Location Address:
507 N NANUM ST RM 30
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:
98926-2886
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
509-925-9821
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
11/01/2016