Provider First Line Business Practice Location Address:
152502 W NORTH RIVER RD
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:
99350-7210
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
509-781-4501
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
11/08/2024