Provider First Line Business Practice Location Address:
9521 SANDIFUR PKWY STE 2
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:
99301-9105
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
509-946-7332
Provider Business Practice Location Address Fax Number:
509-946-1995
Provider Enumeration Date:
03/01/2007