Provider First Line Business Practice Location Address:
1105 DALE AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
BENTON CITY
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
99320-8872
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
509-588-2000
Provider Business Practice Location Address Fax Number:
509-588-5580
Provider Enumeration Date:
10/04/2006