Provider First Line Business Practice Location Address:
4804 W CLEARWATER AVE
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
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
509-942-2235
Provider Business Practice Location Address Fax Number:
509-222-2355
Provider Enumeration Date:
02/02/2012