Provider First Line Business Practice Location Address:
419 N YELM 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:
99336-3001
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
509-783-9895
Provider Business Practice Location Address Fax Number:
509-783-0806
Provider Enumeration Date:
04/09/2007