Provider First Line Business Practice Location Address:
523 1ST AVE NW
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
EPHRATA
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98823-1501
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
509-754-3442
Provider Business Practice Location Address Fax Number:
509-754-0124
Provider Enumeration Date:
10/25/2006