Provider First Line Business Practice Location Address:
1313 W WINE COUNTRY RD STE 101
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
GRANDVIEW
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98930-1015
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
509-882-3273
Provider Business Practice Location Address Fax Number:
509-882-5520
Provider Enumeration Date:
01/24/2007