Provider First Line Business Practice Location Address:
1400 E WASHINGTON AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
UNION GAP
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98903
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
509-248-1073
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
05/03/2007