Provider First Line Business Practice Location Address:
8530 W GAGE BLVD
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:
99336-7162
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
509-380-1562
Provider Business Practice Location Address Fax Number:
509-737-1406
Provider Enumeration Date:
04/28/2010