Provider First Line Business Practice Location Address:
2820 ROAD 72
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:
99301-1919
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
509-727-1416
Provider Business Practice Location Address Fax Number:
509-545-1416
Provider Enumeration Date:
02/16/2022