Provider First Line Business Practice Location Address:
4015 W CLEARWATER AVE
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:
99336-5028
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
509-736-4005
Provider Business Practice Location Address Fax Number:
509-737-9525
Provider Enumeration Date:
02/21/2007