Provider First Line Business Practice Location Address:
1200 N 14TH AVE
Provider Second Line Business Practice Location Address:
#255
Provider Business Practice Location Address City Name:
PASCO
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
99301
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
509-547-7536
Provider Business Practice Location Address Fax Number:
509-544-6648
Provider Enumeration Date:
02/13/2006