Provider First Line Business Practice Location Address:
1209 MEADE AVE
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:
99350-1423
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
509-786-3637
Provider Business Practice Location Address Fax Number:
509-786-7385
Provider Enumeration Date:
10/02/2006