Provider First Line Business Practice Location Address:
3400 W CLEARWATER AVE
Provider Second Line Business Practice Location Address:
SUITE 5
Provider Business Practice Location Address City Name:
KENNEWICK
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
99336-2709
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
509-737-0610
Provider Business Practice Location Address Fax Number:
509-737-8731
Provider Enumeration Date:
04/25/2013