Provider First Line Business Practice Location Address:
8511 W. CLEARWATER AVE.
Provider Second Line Business Practice Location Address:
SUITE A
Provider Business Practice Location Address City Name:
KENNEWICK
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
99336-8578
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
509-736-2318
Provider Business Practice Location Address Fax Number:
509-735-7210
Provider Enumeration Date:
02/23/2009