Provider First Line Business Practice Location Address:
6201 W CLEARWATER AVE
Provider Second Line Business Practice Location Address:
SUITES A & B
Provider Business Practice Location Address City Name:
KENNEWICK
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
99336-1866
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
509-783-5127
Provider Business Practice Location Address Fax Number:
509-737-1228
Provider Enumeration Date:
02/14/2007