Provider First Line Business Practice Location Address:
7223 W CLEARWATER AVE
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:
99336-1758
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
509-783-8822
Provider Business Practice Location Address Fax Number:
509-783-1983
Provider Enumeration Date:
08/22/2007