Provider First Line Business Practice Location Address:
7201 W GRANDRIDGE BLVD
Provider Second Line Business Practice Location Address:
SUITE 101
Provider Business Practice Location Address City Name:
KENNEWICK
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
99336-6709
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
509-735-2325
Provider Business Practice Location Address Fax Number:
509-735-3222
Provider Enumeration Date:
10/06/2005