Provider First Line Business Practice Location Address:
6821 W CLEARWATER AVE
Provider Second Line Business Practice Location Address:
SUITES A AND B
Provider Business Practice Location Address City Name:
KENNEWICK
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
99336-1723
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
509-737-9837
Provider Business Practice Location Address Fax Number:
509-737-9841
Provider Enumeration Date:
11/23/2007