Provider First Line Business Practice Location Address:
507 N NANUM ST
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:
98926-2886
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
509-962-7515
Provider Business Practice Location Address Fax Number:
509-962-7581
Provider Enumeration Date:
05/21/2008