Provider First Line Business Practice Location Address:
700 S, 11TH STREET
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
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
509-839-6822
Provider Business Practice Location Address Fax Number:
509-839-5913
Provider Enumeration Date:
09/15/2022