Provider First Line Business Practice Location Address:
216 N EDISON 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:
99336-1956
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
509-737-0327
Provider Business Practice Location Address Fax Number:
509-737-1360
Provider Enumeration Date:
07/26/2022