Provider First Line Business Practice Location Address:
118 SE 6TH ST
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:
99324-1249
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
509-525-1210
Provider Business Practice Location Address Fax Number:
509-525-1210
Provider Enumeration Date:
08/29/2006