Provider First Line Business Practice Location Address:
1408 N LOUISIANA ST
Provider Second Line Business Practice Location Address:
SUITE 101
Provider Business Practice Location Address City Name:
KENNEWICK
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
99336-7167
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
509-783-6516
Provider Business Practice Location Address Fax Number:
509-783-6980
Provider Enumeration Date:
03/08/2007