Provider First Line Business Practice Location Address:
7101 W HOOD PL
Provider Second Line Business Practice Location Address:
SUITE A-101
Provider Business Practice Location Address City Name:
KENNEWICK
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
99336-6719
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
509-736-5566
Provider Business Practice Location Address Fax Number:
509-736-5536
Provider Enumeration Date:
10/18/2006