Provider First Line Business Practice Location Address:
2211 ROAD 80
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:
99301-1812
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
509-851-7977
Provider Business Practice Location Address Fax Number:
509-318-7688
Provider Enumeration Date:
11/30/2023