Provider First Line Business Practice Location Address:
8033 W GRANDRIDGE BLVD STE C
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:
99336-7159
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
509-783-2225
Provider Business Practice Location Address Fax Number:
509-783-1898
Provider Enumeration Date:
01/23/2025