Provider First Line Business Practice Location Address:
8511 W CLEARWATER AVE STE B
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
KENNEWICK
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
99336-9592
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
509-783-8145
Provider Business Practice Location Address Fax Number:
509-783-8147
Provider Enumeration Date:
09/01/2006