Provider First Line Business Practice Location Address:
412 S 13TH 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:
98944-1571
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
509-837-4213
Provider Business Practice Location Address Fax Number:
509-839-5305
Provider Enumeration Date:
10/03/2006