Provider First Line Business Practice Location Address:
821 S AUBURN ST
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:
99336-5661
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
509-586-3128
Provider Business Practice Location Address Fax Number:
509-586-9051
Provider Enumeration Date:
08/10/2006