Provider First Line Business Practice Location Address:
2420 N AIRPORT RD APT 10101
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:
98926-5159
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
323-347-8921
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
01/08/2025