Provider First Line Business Practice Location Address: 
1175 CARONDELET DR
    Provider Second Line Business Practice Location Address: 
    Provider Business Practice Location Address City Name: 
RICHLAND
    Provider Business Practice Location Address State Name: 
WA
    Provider Business Practice Location Address Postal Code: 
99354-3300
    Provider Business Practice Location Address Country Code: 
US
    Provider Business Practice Location Address Telephone Number: 
509-943-9104
    Provider Business Practice Location Address Fax Number: 
    Provider Enumeration Date: 
01/15/2008