Provider First Line Business Practice Location Address:
51 ALDER 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:
98823-1663
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
509-754-3295
Provider Business Practice Location Address Fax Number:
509-754-3296
Provider Enumeration Date:
02/12/2014