Provider First Line Business Practice Location Address:
228705 GAME FARM RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
KENNEWICK
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
99337
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
509-855-1325
Provider Business Practice Location Address Fax Number:
509-396-9252
Provider Enumeration Date:
08/22/2006