Provider First Line Business Practice Location Address:
4206 W. 24TH AVE. SUITE A 101
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
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
509-783-2949
Provider Business Practice Location Address Fax Number:
509-735-4357
Provider Enumeration Date:
10/17/2012