Provider First Line Business Practice Location Address:
414 N PEARL ST
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:
98926-3112
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
509-925-1514
Provider Business Practice Location Address Fax Number:
509-925-1545
Provider Enumeration Date:
07/14/2006