Provider First Line Business Practice Location Address:
1208 E MOUNT VIEW AVE
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:
98926-9641
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
509-925-4616
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
08/12/2008