Provider First Line Business Practice Location Address:
2110 W HENRY ST
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:
99301-4503
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
509-545-6145
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
02/02/2011