Provider First Line Business Practice Location Address:
714 E EDISON AVE
Provider Second Line Business Practice Location Address:
SUITE B
Provider Business Practice Location Address City Name:
SUNNYSIDE
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98944-2204
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
509-515-0420
Provider Business Practice Location Address Fax Number:
509-515-0422
Provider Enumeration Date:
07/24/2012