Provider First Line Business Practice Location Address:
94505 E GRANADA CT
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:
99338-8894
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
509-303-8346
Provider Business Practice Location Address Fax Number:
509-581-2231
Provider Enumeration Date:
07/10/2026