Provider First Line Business Practice Location Address:
30 S LOUSIANA ST
Provider Second Line Business Practice Location Address:
205
Provider Business Practice Location Address City Name:
KENNEWICK
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
99338
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
509-231-4072
Provider Business Practice Location Address Fax Number:
785-268-8679
Provider Enumeration Date:
09/28/2023