Provider First Line Business Practice Location Address:
3030 W CLEARWATER AVE
Provider Second Line Business Practice Location Address:
SUITE 100
Provider Business Practice Location Address City Name:
KENNEWICK
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
99336-2761
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
509-736-5408
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
06/12/2007