Provider First Line Business Practice Location Address:
1215 E WASHINGTON AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
UNION GAP
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98903-1669
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
509-823-1657
Provider Business Practice Location Address Fax Number:
509-823-1658
Provider Enumeration Date:
01/06/2025