Provider First Line Business Practice Location Address:
531 W PARK ST
Provider Second Line Business Practice Location Address:
SUITE 4
Provider Business Practice Location Address City Name:
PASCO
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
99301-5270
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
509-547-8451
Provider Business Practice Location Address Fax Number:
509-547-8452
Provider Enumeration Date:
06/26/2006