Provider First Line Business Practice Location Address:
3121 W KENNEWICK AVE
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:
99336-2921
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
509-735-7433
Provider Business Practice Location Address Fax Number:
509-735-6577
Provider Enumeration Date:
06/30/2011