Provider First Line Business Practice Location Address:
1532 W SYLVESTER ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
PASCO
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
99301-4844
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
509-547-0523
Provider Business Practice Location Address Fax Number:
509-543-6855
Provider Enumeration Date:
01/25/2007