Provider First Line Business Practice Location Address:
1212 MEADE AVE STE 7
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
PROSSER
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
99350-1482
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
509-832-0432
Provider Business Practice Location Address Fax Number:
509-786-2065
Provider Enumeration Date:
09/13/2007