Provider First Line Business Practice Location Address:
422 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:
98926-3118
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
928-710-8691
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
08/22/2022