Provider First Line Business Practice Location Address:
711 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:
98944-2318
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
509-839-4222
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
02/02/2007