Provider First Line Business Practice Location Address:
130401 W 215 PR NW
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:
99350-8502
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
509-832-2750
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
02/12/2008