Provider First Line Business Practice Location Address:
5221 W CANAL DR
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
KENNEWICK
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
99336-1402
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
509-783-5500
Provider Business Practice Location Address Fax Number:
509-735-3558
Provider Enumeration Date:
02/06/2007