Provider First Line Business Practice Location Address:
3730 PLAZA WAY
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:
99338-2718
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
509-221-6450
Provider Business Practice Location Address Fax Number:
509-221-6230
Provider Enumeration Date:
07/23/2007