Provider First Line Business Practice Location Address:
740 MEMORIAL 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:
99350-1525
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
509-786-1931
Provider Business Practice Location Address Fax Number:
509-786-1997
Provider Enumeration Date:
09/06/2006