Provider First Line Business Practice Location Address:
3620 W 12TH AVE
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:
99338-2111
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
509-430-7946
Provider Business Practice Location Address Fax Number:
888-621-8252
Provider Enumeration Date:
03/31/2007