Provider First Line Business Practice Location Address:
601 E 3RD AVE APT 3
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:
98926-3486
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
206-529-7806
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
07/28/2023