Provider First Line Business Practice Location Address:
2321 ROAD 48
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
PASCO
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
99301-2550
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
253-441-7702
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
02/02/2026