Provider First Line Business Practice Location Address:
1446 SPAULDING AVE
Provider Second Line Business Practice Location Address:
STE 105
Provider Business Practice Location Address City Name:
RICHLAND
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
99352
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
509-420-5066
Provider Business Practice Location Address Fax Number:
509-420-5132
Provider Enumeration Date:
06/03/2014