Provider First Line Business Practice Location Address:
217 S TOPPENISH AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
TOPPENISH
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98948-1780
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
509-865-5121
Provider Business Practice Location Address Fax Number:
509-865-2064
Provider Enumeration Date:
04/20/2015