Provider First Line Business Practice Location Address:
841 E LINCOLN AVE
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:
98944-2347
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
509-839-0414
Provider Business Practice Location Address Fax Number:
509-839-8847
Provider Enumeration Date:
10/16/2008