Provider First Line Business Practice Location Address:
1812 E EDISON AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SUNNYSIDE
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98944
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
509-837-4949
Provider Business Practice Location Address Fax Number:
509-837-2808
Provider Enumeration Date:
06/28/2005