Provider First Line Business Practice Location Address:
1614 E EDISON AVE
Provider Second Line Business Practice Location Address:
SUITE A
Provider Business Practice Location Address City Name:
SUNNYSIDE
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98944-1668
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
509-839-2666
Provider Business Practice Location Address Fax Number:
509-839-3962
Provider Enumeration Date:
01/11/2007