Provider First Line Business Practice Location Address:
1360 N LOUISIANA ST
Provider Second Line Business Practice Location Address:
SUITE D
Provider Business Practice Location Address City Name:
KENNEWICK
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
99336-7171
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
509-735-4247
Provider Business Practice Location Address Fax Number:
509-735-7788
Provider Enumeration Date:
04/24/2012