Provider First Line Business Practice Location Address:
1220 N COLUMBIA CENTER BLVD STE H
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:
99336-1145
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
509-591-9277
Provider Business Practice Location Address Fax Number:
509-737-8935
Provider Enumeration Date:
01/11/2007