Provider First Line Business Practice Location Address:
12335 W EMIG DR
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
LEAVENWORTH
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98826-8750
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
509-219-3204
Provider Business Practice Location Address Fax Number:
509-219-3206
Provider Enumeration Date:
12/14/2015