Provider First Line Business Practice Location Address:
5210 N ROAD 68 STE F
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:
99301-9276
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
509-543-7377
Provider Business Practice Location Address Fax Number:
509-543-7677
Provider Enumeration Date:
10/23/2006