Provider First Line Business Practice Location Address:
5219 W CLEARWATER AVE STE 16
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:
99336-1980
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
509-374-1660
Provider Business Practice Location Address Fax Number:
509-374-9374
Provider Enumeration Date:
06/10/2007