Provider First Line Business Practice Location Address: 
750 SWIFT BLVD STE 15
    Provider Second Line Business Practice Location Address: 
    Provider Business Practice Location Address City Name: 
RICHLAND
    Provider Business Practice Location Address State Name: 
WA
    Provider Business Practice Location Address Postal Code: 
99352-3521
    Provider Business Practice Location Address Country Code: 
US
    Provider Business Practice Location Address Telephone Number: 
509-940-5577
    Provider Business Practice Location Address Fax Number: 
509-834-7286
    Provider Enumeration Date: 
12/31/2014