Provider First Line Business Practice Location Address:
419 N D ST
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:
98948-1201
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
509-830-4643
Provider Business Practice Location Address Fax Number:
509-865-2682
Provider Enumeration Date:
12/18/2007