Provider First Line Business Practice Location Address:
501 'C' ST NW
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
EPHRATA
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98823
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
509-754-2474
Provider Business Practice Location Address Fax Number:
509-754-4712
Provider Enumeration Date:
10/03/2006