Provider First Line Business Practice Location Address:
1200 N 14TH AVE
Provider Second Line Business Practice Location Address:
#240
Provider Business Practice Location Address City Name:
PASCO
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
99301-4182
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
509-547-0675
Provider Business Practice Location Address Fax Number:
509-547-0584
Provider Enumeration Date:
04/25/2006