Provider First Line Business Practice Location Address:
412 S ALDER ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
TOPPENISH
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98948-1626
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
509-490-0602
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
04/30/2026