Provider First Line Business Practice Location Address:
1500 GRANT AVE
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:
99350-1122
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
509-786-1820
Provider Business Practice Location Address Fax Number:
509-786-9672
Provider Enumeration Date:
06/25/2008