Provider First Line Business Practice Location Address:
103 1ST AVE SW
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
EPHRATA
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98823-1842
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
509-754-5236
Provider Business Practice Location Address Fax Number:
509-754-3248
Provider Enumeration Date:
10/25/2006