Provider First Line Business Practice Location Address:
213 S OSBORNE 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:
99336-6112
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
323-545-8365
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
03/10/2025