Provider First Line Business Practice Location Address:
2810 E LINCOLN AVE STE G
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:
98944-9799
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
509-567-6666
Provider Business Practice Location Address Fax Number:
509-213-2817
Provider Enumeration Date:
01/12/2023