Provider First Line Business Practice Location Address:
5219 W CLEARWATER AVE
Provider Second Line Business Practice Location Address:
SUITE 12A
Provider Business Practice Location Address City Name:
KENNEWICK
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
99336-1914
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
509-374-4485
Provider Business Practice Location Address Fax Number:
509-547-3414
Provider Enumeration Date:
03/29/2007