Provider First Line Business Practice Location Address:
518 WEST FIRST AVE.
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
TOPPENISH
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98948
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
509-454-4143
Provider Business Practice Location Address Fax Number:
509-454-3651
Provider Enumeration Date:
07/10/2007