Provider First Line Business Practice Location Address:
8121 W. QUINAULT AVE.
Provider Second Line Business Practice Location Address:
SUITE F202
Provider Business Practice Location Address City Name:
KENNEWICK
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
99336
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
509-579-0200
Provider Business Practice Location Address Fax Number:
509-232-0216
Provider Enumeration Date:
08/30/2006