Provider First Line Business Practice Location Address:
3208 W 19TH AVE
Provider Second Line Business Practice Location Address:
STE 101
Provider Business Practice Location Address City Name:
KENNEWICK
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
99337-2318
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
509-582-1677
Provider Business Practice Location Address Fax Number:
509-585-5535
Provider Enumeration Date:
09/27/2011