Provider First Line Business Practice Location Address:
421 N PEARL ST
Provider Second Line Business Practice Location Address:
SUITE 219
Provider Business Practice Location Address City Name:
ELLENSBURG
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98926-3193
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
509-962-9252
Provider Business Practice Location Address Fax Number:
509-962-9278
Provider Enumeration Date:
03/09/2007