Provider First Line Business Practice Location Address:
1200 NORTH 14TH AVENUE
Provider Second Line Business Practice Location Address:
SUITE 275
Provider Business Practice Location Address City Name:
PASCO
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
99301-4079
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
509-545-0414
Provider Business Practice Location Address Fax Number:
509-545-9398
Provider Enumeration Date:
12/20/2006