Provider First Line Business Practice Location Address:
424 S WASHINGTON 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:
99336-3950
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
509-586-6248
Provider Business Practice Location Address Fax Number:
509-586-7928
Provider Enumeration Date:
01/22/2006