Provider First Line Business Practice Location Address:
516 W MARGARET ST
Provider Second Line Business Practice Location Address:
SUITE 10
Provider Business Practice Location Address City Name:
PASCO
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
99301-5273
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
509-543-4166
Provider Business Practice Location Address Fax Number:
509-544-0331
Provider Enumeration Date:
12/27/2006