Provider First Line Business Practice Location Address:
1620 N ROAD 44
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
PASCO
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
99301-2667
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
509-544-2156
Provider Business Practice Location Address Fax Number:
509-544-2158
Provider Enumeration Date:
09/17/2012