Provider First Line Business Practice Location Address:
315 W 1ST AVE
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:
99336-3928
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
509-586-9691
Provider Business Practice Location Address Fax Number:
509-582-3661
Provider Enumeration Date:
09/28/2006