Provider First Line Business Practice Location Address:
813 S AUBURN ST
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:
99336-5661
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
509-586-8986
Provider Business Practice Location Address Fax Number:
509-586-0314
Provider Enumeration Date:
01/30/2008