Provider First Line Business Practice Location Address:
803 E LINCOLN AVE
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:
98944-2383
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
509-837-6911
Provider Business Practice Location Address Fax Number:
509-837-6920
Provider Enumeration Date:
05/04/2006