Provider First Line Business Practice Location Address:
1205 S.E.PRO-MALL BLVD.
Provider Second Line Business Practice Location Address:
SUITE #201
Provider Business Practice Location Address City Name:
PULLMAN
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
99163
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
509-332-2366
Provider Business Practice Location Address Fax Number:
509-334-1931
Provider Enumeration Date:
10/12/2006