Provider First Line Business Practice Location Address:
4719 W MARGARET ST
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:
99301-2822
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
909-486-3206
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
12/27/2005