Provider First Line Business Practice Location Address:
1000 W. 4TH 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
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
509-222-5261
Provider Business Practice Location Address Fax Number:
509-222-5054
Provider Enumeration Date:
08/18/2008