Provider First Line Business Practice Location Address:
5908 BEDFORD ST STE C
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:
99301-6605
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
509-792-1404
Provider Business Practice Location Address Fax Number:
509-792-1404
Provider Enumeration Date:
06/30/2009