Provider First Line Business Practice Location Address:
11 GRANT RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
EAST WENATCHEE
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98802-7726
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
509-881-2833
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
04/10/2023