Provider First Line Business Practice Location Address:
1812 E EDISON 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:
98944-1653
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
509-249-5242
Provider Business Practice Location Address Fax Number:
509-249-5244
Provider Enumeration Date:
09/21/2018