Provider First Line Business Practice Location Address:
803 E LINCOLN AVE STE E
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SUNNYSIDE
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98944-2383
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
509-837-8655
Provider Business Practice Location Address Fax Number:
509-837-3750
Provider Enumeration Date:
12/14/2006