Provider First Line Business Practice Location Address:
1120 N 22ND AVE
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:
99301-3901
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
509-543-6798
Provider Business Practice Location Address Fax Number:
509-546-2854
Provider Enumeration Date:
09/27/2022