Provider First Line Business Practice Location Address:
6855 W CLEARWATER AVE STE K
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:
99336-1720
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
509-521-3690
Provider Business Practice Location Address Fax Number:
888-729-9667
Provider Enumeration Date:
07/11/2008