Provider First Line Business Practice Location Address:
1350 N GRANT ST
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:
99336-1355
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
509-783-5465
Provider Business Practice Location Address Fax Number:
509-735-3980
Provider Enumeration Date:
07/26/2023