Provider First Line Business Practice Location Address:
633 W 1ST ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
WAPATO
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98951-1107
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
509-584-0300
Provider Business Practice Location Address Fax Number:
509-584-0302
Provider Enumeration Date:
11/26/2019