Provider First Line Business Practice Location Address:
815 SE KLEMGARD 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:
99163-5430
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
509-288-2218
Provider Business Practice Location Address Fax Number:
801-495-5298
Provider Enumeration Date:
10/29/2008