Provider First Line Business Practice Location Address:
7809 N ROAD 36
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
PASCO
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
99301-9309
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
509-547-9306
Provider Business Practice Location Address Fax Number:
509-547-2535
Provider Enumeration Date:
02/27/2013