Provider First Line Business Practice Location Address:
512 N YOUNG ST STE C
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:
99336-7839
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
509-735-3555
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
01/27/2020