Provider First Line Business Practice Location Address:
136 EAST JOHNSON AVE
Provider Second Line Business Practice Location Address:
SUITE 1
Provider Business Practice Location Address City Name:
CHELAN
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98816-1890
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
509-888-5477
Provider Business Practice Location Address Fax Number:
509-888-5352
Provider Enumeration Date:
02/13/2018