Provider First Line Business Practice Location Address:
30 S LOUISIANA 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:
99336-9002
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
509-975-2501
Provider Business Practice Location Address Fax Number:
509-463-4563
Provider Enumeration Date:
08/14/2025