Provider First Line Business Practice Location Address:
336 CHARDONNAY AVE STE A
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
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
509-786-2002
Provider Business Practice Location Address Fax Number:
509-786-2026
Provider Enumeration Date:
09/21/2012