Provider First Line Business Practice Location Address:
824 W LEWIS ST
Provider Second Line Business Practice Location Address:
SUITE 204
Provider Business Practice Location Address City Name:
PASCO
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
99301-5561
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
509-544-0265
Provider Business Practice Location Address Fax Number:
509-544-0304
Provider Enumeration Date:
12/14/2006