Provider First Line Business Practice Location Address:
19116 E TERRAPIN LN
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
OTIS ORCHARDS
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
99027-8211
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
602-540-6583
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
06/27/2026