Provider First Line Business Practice Location Address:
101 11TH ST NE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
EAST WENATCHEE
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98802-4481
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
509-886-0131
Provider Business Practice Location Address Fax Number:
509-884-8153
Provider Enumeration Date:
05/30/2007