Provider First Line Business Practice Location Address:
108 W MAIN AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
RITZVILLE
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
99169-1408
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
509-659-3315
Provider Business Practice Location Address Fax Number:
509-659-4109
Provider Enumeration Date:
09/27/2006