Provider First Line Business Practice Location Address:
5025 W CLEARWATER AVE
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:
99336-1911
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
509-783-0822
Provider Business Practice Location Address Fax Number:
509-736-3504
Provider Enumeration Date:
10/17/2006