Provider First Line Business Practice Location Address:
106 ASH ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
GRANDVIEW
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98930-1317
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
509-738-8000
Provider Business Practice Location Address Fax Number:
509-213-2815
Provider Enumeration Date:
01/12/2023