Provider First Line Business Practice Location Address:
1150 BASIN ST SW
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:
98823-2138
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
509-754-3567
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
02/21/2025