Provider First Line Business Practice Location Address:
510 W 1ST AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
TOPPENISH
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98948-1564
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
509-865-5600
Provider Business Practice Location Address Fax Number:
509-865-5783
Provider Enumeration Date:
07/07/2006