Provider First Line Business Practice Location Address:
301 S WAPATO AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
WAPATO
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98951-1346
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
509-877-2707
Provider Business Practice Location Address Fax Number:
509-877-2577
Provider Enumeration Date:
06/22/2005