Provider First Line Business Practice Location Address:
6855 W CLEARWATER AVE STE K
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:
99336-1720
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
509-956-4616
Provider Business Practice Location Address Fax Number:
509-210-5714
Provider Enumeration Date:
04/01/2008