Provider First Line Business Practice Location Address:
8656 W GAGE BLVD STE 202
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:
99336-7145
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
509-987-1246
Provider Business Practice Location Address Fax Number:
509-987-1247
Provider Enumeration Date:
05/27/2005