Provider First Line Business Practice Location Address:
5701 BEDFORD ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
PASCO
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
99301-8214
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
509-792-1008
Provider Business Practice Location Address Fax Number:
509-792-1048
Provider Enumeration Date:
01/23/2015