Provider First Line Business Practice Location Address:
1319 SAUL 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:
98944-2300
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
509-837-2089
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
01/16/2007