Provider First Line Business Practice Location Address:
216 W 10TH AVE., STE. 204
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
KENNEWICK
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
99336
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
509-585-5340
Provider Business Practice Location Address Fax Number:
509-585-5341
Provider Enumeration Date:
03/27/2007