Provider First Line Business Practice Location Address:
8102 W GRANDRIDGE BLVD
Provider Second Line Business Practice Location Address:
SUITE A
Provider Business Practice Location Address City Name:
KENNEWICK
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
99336-7157
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
509-735-7461
Provider Business Practice Location Address Fax Number:
509-783-8167
Provider Enumeration Date:
09/03/2008