Provider First Line Business Practice Location Address:
5908 BEDFORD ST
Provider Second Line Business Practice Location Address:
SUITE C
Provider Business Practice Location Address City Name:
PASCO
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
99301-6605
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
509-547-4724
Provider Business Practice Location Address Fax Number:
509-547-2056
Provider Enumeration Date:
06/14/2005