Provider First Line Business Practice Location Address:
2925 ALLEN RD
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:
98944-8931
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
509-837-1570
Provider Business Practice Location Address Fax Number:
509-837-2236
Provider Enumeration Date:
08/21/2006