Provider First Line Business Practice Location Address:
301 N 1ST ST STE D
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SUNNYSIDE
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98944-1465
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
509-836-0075
Provider Business Practice Location Address Fax Number:
509-575-5743
Provider Enumeration Date:
12/13/2006