Provider First Line Business Practice Location Address:
250 BASIN ST SW
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
EPHRATA
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98823-1852
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
509-754-3513
Provider Business Practice Location Address Fax Number:
509-754-2714
Provider Enumeration Date:
04/07/2021