Provider First Line Business Practice Location Address:
107 E MOUNTAIN 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:
98926-5312
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
509-962-6348
Provider Business Practice Location Address Fax Number:
509-962-2003
Provider Enumeration Date:
07/20/2006