Provider First Line Business Practice Location Address:
1413 EAST EDISON AVE.
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SUNNYSIDE
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98944-1622
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
509-837-1617
Provider Business Practice Location Address Fax Number:
509-837-4908
Provider Enumeration Date:
09/13/2012