Provider First Line Business Practice Location Address:
5025 N ROAD 68
Provider Second Line Business Practice Location Address:
SUITE B
Provider Business Practice Location Address City Name:
PASCO
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
99301-9175
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
509-430-3214
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
05/03/2007