Provider First Line Business Practice Location Address:
7211 W DESCHUTES AVE
Provider Second Line Business Practice Location Address:
SUITE D201
Provider Business Practice Location Address City Name:
KENNEWICK
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
99336-7715
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
509-783-8195
Provider Business Practice Location Address Fax Number:
509-783-8265
Provider Enumeration Date:
05/16/2006