Provider First Line Business Practice Location Address:
8400 W. GAGE BLVD
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:
509-735-9548
Provider Business Practice Location Address Fax Number:
509-735-6876
Provider Enumeration Date:
09/16/2006