Provider First Line Business Practice Location Address:
9221 SANDIFUR PKWY STE A
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
PASCO
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
99301-9241
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
509-233-7546
Provider Business Practice Location Address Fax Number:
509-795-3508
Provider Enumeration Date:
03/14/2011