Provider First Line Business Practice Location Address:
30 MERLOT DRIVE
Provider Second Line Business Practice Location Address:
SUITE F
Provider Business Practice Location Address City Name:
PROSSER
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
99350
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
509-303-9947
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
12/15/2006