Provider First Line Business Practice Location Address:
521 N YOUNG 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:
99336-7806
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
509-221-5965
Provider Business Practice Location Address Fax Number:
509-221-6330
Provider Enumeration Date:
04/01/2024