Provider First Line Business Practice Location Address:
5219 W CLEARWATER AVE
Provider Second Line Business Practice Location Address:
SUITE 3
Provider Business Practice Location Address City Name:
KENNEWICK
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
99336-1914
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
509-374-1660
Provider Business Practice Location Address Fax Number:
509-374-9374
Provider Enumeration Date:
03/31/2010