Provider First Line Business Practice Location Address:
5219 W CLEARWATER AVE
Provider Second Line Business Practice Location Address:
SUITE 15
Provider Business Practice Location Address City Name:
KENNEWICK
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
99336-1914
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
509-783-3744
Provider Business Practice Location Address Fax Number:
509-736-0771
Provider Enumeration Date:
07/04/2006