Provider First Line Business Practice Location Address:
201 W BROADWAY AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
RITZVILLE
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
99169-1846
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
509-660-0741
Provider Business Practice Location Address Fax Number:
509-659-4013
Provider Enumeration Date:
02/14/2007