Provider First Line Business Practice Location Address:
340 NE MAPLE ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
PULLMAN
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
99163-4120
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
509-334-1133
Provider Business Practice Location Address Fax Number:
509-332-1608
Provider Enumeration Date:
08/29/2011