Provider First Line Business Practice Location Address:
722 SOUTH COLLEGE AVENUE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
COLLEGE PLACE
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
99324
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
509-524-8023
Provider Business Practice Location Address Fax Number:
509-691-6317
Provider Enumeration Date:
01/12/2006