Provider First Line Business Practice Location Address:
7513 W KENNEWICK AVE
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:
99336-7764
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
509-735-4343
Provider Business Practice Location Address Fax Number:
509-736-5414
Provider Enumeration Date:
07/11/2006