Provider First Line Business Practice Location Address:
711 S AUBURN ST STE P
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:
99336-5665
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
509-460-4823
Provider Business Practice Location Address Fax Number:
509-460-4833
Provider Enumeration Date:
03/30/2012