Provider First Line Business Practice Location Address:
490 YAKIMA RIVER DR
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:
98926-8598
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
509-964-2073
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
02/08/2007