Provider First Line Business Practice Location Address:
1120 SO 4TH ST
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:
98944-1120
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
509-837-2600
Provider Business Practice Location Address Fax Number:
509-837-2291
Provider Enumeration Date:
09/20/2006