Provider First Line Business Practice Location Address:
320 W 10TH AVE
Provider Second Line Business Practice Location Address:
SUITE 202
Provider Business Practice Location Address City Name:
KENNEWICK
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
99336-6302
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
509-586-5113
Provider Business Practice Location Address Fax Number:
509-586-5143
Provider Enumeration Date:
05/19/2006