Provider First Line Business Practice Location Address:
4309 W. 27TH PL
Provider Second Line Business Practice Location Address:
300
Provider Business Practice Location Address City Name:
KENNIWICK
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
99338
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
509-783-9848
Provider Business Practice Location Address Fax Number:
509-783-9860
Provider Enumeration Date:
07/20/2006