Provider First Line Business Practice Location Address:
710 S EVERETT 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:
99336-7159
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
509-430-6801
Provider Business Practice Location Address Fax Number:
509-582-9578
Provider Enumeration Date:
08/14/2007