Provider First Line Business Practice Location Address:
215 W. WEBSTER
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
CHELAN
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98816-0369
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
509-682-4061
Provider Business Practice Location Address Fax Number:
509-682-0558
Provider Enumeration Date:
04/16/2019