Provider First Line Business Practice Location Address:
21 C ST SW
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
EPHRATA
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98823-1841
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
509-760-2046
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
11/02/2007