Provider First Line Business Practice Location Address:
916 N 16TH ST
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:
98944-8714
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
509-836-8500
Provider Business Practice Location Address Fax Number:
509-836-8515
Provider Enumeration Date:
12/17/2014