Provider First Line Business Practice Location Address:
228 EPHRATA AVE NW
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SOAP LAKE
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98851-9605
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
509-237-0672
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
03/06/2014