Provider First Line Business Practice Location Address:
2131 WINE COUNTRY RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
PROSSER
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
99350-1389
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
509-796-3300
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
11/01/2007