Provider First Line Business Practice Location Address:
10505 W CLEARWATER AVE
Provider Second Line Business Practice Location Address:
BLDG A
Provider Business Practice Location Address City Name:
KENNEWICK
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
99336-8613
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
509-735-9735
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
10/15/2007