Provider First Line Business Practice Location Address:
1070 BASIN ST SW STE F
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:
98823-1005
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
509-754-2020
Provider Business Practice Location Address Fax Number:
509-754-9243
Provider Enumeration Date:
09/02/2010