Provider First Line Business Practice Location Address:
7221 W DESCHUTES AVE
Provider Second Line Business Practice Location Address:
STE C
Provider Business Practice Location Address City Name:
KENNEWICK
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
99336-7807
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
509-374-3105
Provider Business Practice Location Address Fax Number:
509-374-3108
Provider Enumeration Date:
05/24/2005