Provider First Line Business Practice Location Address:
3231 W 13TH 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:
99338-2121
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
509-396-7189
Provider Business Practice Location Address Fax Number:
509-987-1248
Provider Enumeration Date:
03/26/2025