Provider First Line Business Practice Location Address:
519 S 6TH ST STE 6
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:
98944-2102
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
509-836-5552
Provider Business Practice Location Address Fax Number:
509-836-0690
Provider Enumeration Date:
10/25/2019