Provider First Line Business Practice Location Address:
1721 W KENNEWICK AVE STE 1A
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:
99336-3377
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
509-582-3549
Provider Business Practice Location Address Fax Number:
509-586-4313
Provider Enumeration Date:
06/19/2007