Provider First Line Business Practice Location Address:
2695 E LINCOLN AVE
Provider Second Line Business Practice Location Address:
STE C
Provider Business Practice Location Address City Name:
SUNNYSIDE
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98944-4003
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
509-836-2818
Provider Business Practice Location Address Fax Number:
509-836-2235
Provider Enumeration Date:
08/25/2016