Provider First Line Business Practice Location Address:
55306 N WHAN RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
BENTON CITY
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
99320-5603
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
509-386-3783
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
10/30/2026