Provider First Line Business Practice Location Address:
9825 SANDIFUR PKWY STE D
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
PASCO
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
99301-6738
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
509-438-7722
Provider Business Practice Location Address Fax Number:
509-967-4736
Provider Enumeration Date:
09/27/2006