Provider First Line Business Practice Location Address:
408 BASIN ST. NW
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:
98823-1630
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
509-754-6100
Provider Business Practice Location Address Fax Number:
503-754-6112
Provider Enumeration Date:
05/07/2010