Provider First Line Business Practice Location Address:
4307 S WASHINGTON 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:
99337-5215
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
509-585-8292
Provider Business Practice Location Address Fax Number:
509-585-2484
Provider Enumeration Date:
09/30/2006