Provider First Line Business Practice Location Address:
124 W KENNEWICK AVE UNIT 12
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
KENNEWICK
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
99336-3830
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
509-374-7588
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
06/24/2026