Provider First Line Business Practice Location Address:
4090 E EDISON RD
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:
98944-9639
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
509-837-5453
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
09/12/2008