Provider First Line Business Practice Location Address:
1455 COLORADO ST
Provider Second Line Business Practice Location Address:
BOHLER ATHLETIC COMPLEX M4
Provider Business Practice Location Address City Name:
PULLMAN
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
99164-0001
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
509-335-8936
Provider Business Practice Location Address Fax Number:
509-335-4729
Provider Enumeration Date:
06/17/2014