Provider First Line Business Practice Location Address:
900 S DAYTON 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:
99336-5667
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
509-582-4142
Provider Business Practice Location Address Fax Number:
509-586-3825
Provider Enumeration Date:
07/19/2019