Provider First Line Business Practice Location Address:
5168 W LATTIN RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
WEST RICHLAND
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
99353-4018
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
360-731-8185
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
05/04/2026