Provider First Line Business Practice Location Address:
90601 W HANKS RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
PROSSER
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
99350-8617
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
509-973-3180
Provider Business Practice Location Address Fax Number:
509-973-2210
Provider Enumeration Date:
11/30/2007