Provider First Line Business Practice Location Address:
6818 W KENNEWICK AVE STE C
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:
99336-1754
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
509-374-5775
Provider Business Practice Location Address Fax Number:
509-374-8065
Provider Enumeration Date:
07/02/2006