Provider First Line Business Practice Location Address:
111 K ST NE
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:
98823-1747
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
253-905-6761
Provider Business Practice Location Address Fax Number:
253-231-3475
Provider Enumeration Date:
11/09/2007