Provider First Line Business Practice Location Address:
1359 HIGHWAY 28 W UNIT 18
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
EPHRATA
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98823-9689
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
509-388-5857
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
09/17/2025