Provider First Line Business Practice Location Address:
117 S. 3RD AVE.
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
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
509-542-8890
Provider Business Practice Location Address Fax Number:
866-204-7309
Provider Enumeration Date:
12/02/2009