Provider First Line Business Practice Location Address:
2624 W DESCHUTES 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:
99336-3003
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
509-737-8322
Provider Business Practice Location Address Fax Number:
509-737-1290
Provider Enumeration Date:
05/02/2006