Provider First Line Business Practice Location Address:
115 S 10TH AVE
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:
99301-6806
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
509-545-0596
Provider Business Practice Location Address Fax Number:
509-547-3355
Provider Enumeration Date:
03/23/2011