Provider First Line Business Practice Location Address:
314 N PINE 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:
98926-3366
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
360-791-6226
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
07/13/2018