Provider First Line Business Practice Location Address:
1701 N YOUNG ST
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:
99336-1129
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
509-222-5945
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
10/30/2012