Provider First Line Business Practice Location Address:
705 7TH ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
PROSSER
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
99350-1457
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
509-832-1716
Provider Business Practice Location Address Fax Number:
509-786-7694
Provider Enumeration Date:
11/21/2006