Provider First Line Business Practice Location Address:
2810 W CLEARWATER AVE
Provider Second Line Business Practice Location Address:
SUITE 103
Provider Business Practice Location Address City Name:
KENNEWICK
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
99336-2963
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
509-783-7333
Provider Business Practice Location Address Fax Number:
509-783-1980
Provider Enumeration Date:
10/03/2012