Provider First Line Business Practice Location Address:
1301 N EPHRATA AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
CONNELL
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
99326-9601
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
509-543-5800
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
05/19/2020