Provider First Line Business Practice Location Address:
8911 W GRANDRIDGE BLVD
Provider Second Line Business Practice Location Address:
SUITE I
Provider Business Practice Location Address City Name:
KENNEWICK
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
99336
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
509-783-3332
Provider Business Practice Location Address Fax Number:
509-783-3332
Provider Enumeration Date:
04/29/2008