Provider First Line Business Practice Location Address:
413 N MAIN ST
Provider Second Line Business Practice Location Address:
SUITE J
Provider Business Practice Location Address City Name:
ELLENSBURG
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98926-3183
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
509-899-0226
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
07/06/2016