Provider First Line Business Practice Location Address:
1005 N F ST
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:
99161-8719
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
509-715-9157
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
02/01/2010