Provider First Line Business Practice Location Address:
30 S LOUISIANA ST STE 224
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:
99336-9003
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
509-392-1190
Provider Business Practice Location Address Fax Number:
509-769-0933
Provider Enumeration Date:
12/11/2012