Provider First Line Business Practice Location Address:
1307 W COURT ST STE 2
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:
99301-4104
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
509-544-0911
Provider Business Practice Location Address Fax Number:
509-544-0922
Provider Enumeration Date:
08/14/2007