Provider First Line Business Practice Location Address:
6601 W DESCHUTES AVE
Provider Second Line Business Practice Location Address:
SUITE D
Provider Business Practice Location Address City Name:
KENNEWICK
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
99336-7811
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
509-378-1645
Provider Business Practice Location Address Fax Number:
509-582-1118
Provider Enumeration Date:
12/28/2006