Provider First Line Business Practice Location Address:
516 W MARGARET
Provider Second Line Business Practice Location Address:
SUITE 9
Provider Business Practice Location Address City Name:
PASCO
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
99301
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
509-542-8232
Provider Business Practice Location Address Fax Number:
509-547-6747
Provider Enumeration Date:
02/07/2006