Provider First Line Business Practice Location Address:
324 5TH AVE SE
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:
98823-2260
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
509-855-6092
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
11/10/2025