Provider First Line Business Practice Location Address:
3730 PLAZA WAY
Provider Second Line Business Practice Location Address:
5TH FLOOR, TRIOS CARE CENTER SOUTHRIDGE
Provider Business Practice Location Address City Name:
KENNEWICK
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:
509-221-5969
Provider Business Practice Location Address Fax Number:
509-586-5143
Provider Enumeration Date:
06/07/2012