Provider First Line Business Practice Location Address:
1423 E EDISON AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SUNNYSIDE
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98944-1667
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
509-837-6789
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
04/18/2007