Provider First Line Business Practice Location Address:
815 S AUBURN ST
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:
99336-5661
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
509-586-5109
Provider Business Practice Location Address Fax Number:
509-586-5174
Provider Enumeration Date:
08/17/2006