Provider First Line Business Practice Location Address:
4403 W COURT ST
Provider Second Line Business Practice Location Address:
SUITE B
Provider Business Practice Location Address City Name:
PASCO
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
99301-2879
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
509-545-6620
Provider Business Practice Location Address Fax Number:
509-545-6842
Provider Enumeration Date:
05/31/2006