Provider First Line Business Practice Location Address:
8127 W GRANDRIDGE BLVD
Provider Second Line Business Practice Location Address:
SUITE 110
Provider Business Practice Location Address City Name:
KENNEWICK
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
99336-7166
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
509-783-8383
Provider Business Practice Location Address Fax Number:
509-735-2592
Provider Enumeration Date:
05/18/2006