Provider First Line Business Practice Location Address:
720 W COURT ST
Provider Second Line Business Practice Location Address:
SUITE 8 NUEVA ESPERANZA
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:
509-545-6506
Provider Business Practice Location Address Fax Number:
509-546-0520
Provider Enumeration Date:
04/13/2007