Provider First Line Business Practice Location Address:
2519 MAIN STREET
Provider Second Line Business Practice Location Address:
RITE AID PHARMACY
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:
509-453-3603
Provider Business Practice Location Address Fax Number:
509-248-2875
Provider Enumeration Date:
11/04/2008