Provider First Line Business Practice Location Address:
318 S 7TH ST
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:
98944-1503
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
509-830-7326
Provider Business Practice Location Address Fax Number:
509-469-1905
Provider Enumeration Date:
12/07/2017