Provider First Line Business Practice Location Address:
100 E JACKSON AVE
Provider Second Line Business Practice Location Address:
SUITE 102
Provider Business Practice Location Address City Name:
ELLENSBURG
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98926-3692
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
509-453-4614
Provider Business Practice Location Address Fax Number:
509-225-2712
Provider Enumeration Date:
05/08/2017