Provider First Line Business Practice Location Address:
1320 N 4TH AVE STE A
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:
99301-3711
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
509-792-1130
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
04/19/2007