Provider First Line Business Practice Location Address:
6722 W KENNEWICK AVE
Provider Second Line Business Practice Location Address:
SUITE B
Provider Business Practice Location Address City Name:
KENNEWICK
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
99336-1793
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
509-554-4167
Provider Business Practice Location Address Fax Number:
866-300-0363
Provider Enumeration Date:
02/07/2008