Provider First Line Business Practice Location Address:
660 GEORGE WASHINGTON WAY
Provider Second Line Business Practice Location Address:
SUITE B
Provider Business Practice Location Address City Name:
RICHLAND
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
99352-4246
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
509-946-8778
Provider Business Practice Location Address Fax Number:
509-946-3887
Provider Enumeration Date:
04/24/2007