Provider First Line Business Practice Location Address:
425 S TWEEDT 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:
99336-4342
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
509-222-6703
Provider Business Practice Location Address Fax Number:
509-222-6701
Provider Enumeration Date:
09/15/2022