Provider First Line Business Practice Location Address:
518 W 1ST 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:
98948-1564
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
509-865-6677
Provider Business Practice Location Address Fax Number:
509-865-2665
Provider Enumeration Date:
11/28/2012