Provider First Line Business Practice Location Address:
501 W 4TH 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:
98948-1615
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
509-865-3141
Provider Business Practice Location Address Fax Number:
509-865-7388
Provider Enumeration Date:
04/17/2009