Provider First Line Business Practice Location Address:
235 E MAIN STREET
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
PALOUSE
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
99161
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
509-878-8000
Provider Business Practice Location Address Fax Number:
509-878-8008
Provider Enumeration Date:
06/23/2005