Provider First Line Business Practice Location Address:
6304 W RICHARDSON RD
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:
99301-1911
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
509-851-3280
Provider Business Practice Location Address Fax Number:
509-349-5069
Provider Enumeration Date:
03/23/2013