Provider First Line Business Practice Location Address:
516 W MARGARET
Provider Second Line Business Practice Location Address:
SUITE 2
Provider Business Practice Location Address City Name:
PASCO
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
99301
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
509-544-2156
Provider Business Practice Location Address Fax Number:
509-544-2158
Provider Enumeration Date:
08/23/2006