Provider First Line Business Practice Location Address:
101 N ELY 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:
99336-2941
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
509-783-1438
Provider Business Practice Location Address Fax Number:
509-783-3321
Provider Enumeration Date:
04/27/2011