Provider First Line Business Practice Location Address:
6503 W HOOD PL
Provider Second Line Business Practice Location Address:
STE A
Provider Business Practice Location Address City Name:
KENNEWICK
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
99336-5110
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
509-783-8413
Provider Business Practice Location Address Fax Number:
509-735-2331
Provider Enumeration Date:
08/19/2006