Provider First Line Business Practice Location Address:
820 MEMORIAL ST STE 1
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
PROSSER
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
99350-2504
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
509-786-2010
Provider Business Practice Location Address Fax Number:
509-788-1794
Provider Enumeration Date:
03/01/2011