Provider First Line Business Practice Location Address:
4303 W 27TH AVE
Provider Second Line Business Practice Location Address:
SUITE C
Provider Business Practice Location Address City Name:
KENNEWICK
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
99338-1986
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
509-783-8977
Provider Business Practice Location Address Fax Number:
509-783-6151
Provider Enumeration Date:
11/16/2006