Provider First Line Business Practice Location Address:
5619 W CLEARWATER
Provider Second Line Business Practice Location Address:
SUITE 6
Provider Business Practice Location Address City Name:
KENNEWICK
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:
509-783-4454
Provider Business Practice Location Address Fax Number:
509-783-6601
Provider Enumeration Date:
02/20/2007