Provider First Line Business Practice Location Address:
3311 W CLEARWATER AVE
Provider Second Line Business Practice Location Address:
SUITE C-200D
Provider Business Practice Location Address City Name:
KENNEWICK
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
99336-2710
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
509-491-8191
Provider Business Practice Location Address Fax Number:
509-396-7556
Provider Enumeration Date:
12/13/2011