Provider First Line Business Practice Location Address:
1229 W 22ND PL
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:
99337-7812
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
509-222-5203
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
09/23/2022