Provider First Line Business Practice Location Address:
201 N EDISON ST STE 233
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:
99336-1983
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
509-987-1712
Provider Business Practice Location Address Fax Number:
509-987-1715
Provider Enumeration Date:
10/01/2009