Provider First Line Business Practice Location Address:
781 KAYNOR RD
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:
98926-8691
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
509-929-4207
Provider Business Practice Location Address Fax Number:
509-349-5055
Provider Enumeration Date:
08/09/2019