Provider First Line Business Practice Location Address:
7405 THREE RIVERS DR
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
PASCO
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
99301-6944
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
509-488-5256
Provider Business Practice Location Address Fax Number:
509-488-9939
Provider Enumeration Date:
01/28/2026