Provider First Line Business Practice Location Address:
312 W 2ND ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
WAPATO
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98951-1110
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
509-877-7271
Provider Business Practice Location Address Fax Number:
509-877-3532
Provider Enumeration Date:
01/30/2007