Provider First Line Business Practice Location Address:
401 BUSTER ROAD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
TOPPENISH
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98948
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
509-874-2979
Provider Business Practice Location Address Fax Number:
509-874-2113
Provider Enumeration Date:
08/13/2007