Provider First Line Business Practice Location Address:
1055 RIDGE CREST DRIVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
WENATCHEE
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98801
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
509-630-0389
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
04/07/2010