Provider First Line Business Practice Location Address:
8019 QUINAULT AVE
Provider Second Line Business Practice Location Address:
SUITE 203
Provider Business Practice Location Address City Name:
KENNEWICK
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
99336
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
509-735-1111
Provider Business Practice Location Address Fax Number:
509-735-1125
Provider Enumeration Date:
08/25/2006