Provider First Line Business Practice Location Address:
502 W 1ST ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
WAPATO
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98951-1106
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
509-877-2085
Provider Business Practice Location Address Fax Number:
509-877-2035
Provider Enumeration Date:
03/27/2018