Provider First Line Business Practice Location Address:
1721 E LINCOLN 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:
98944-2478
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
509-837-7178
Provider Business Practice Location Address Fax Number:
509-837-3117
Provider Enumeration Date:
01/14/2016