Provider First Line Business Practice Location Address:
825 SE BISHOP BLVD
Provider Second Line Business Practice Location Address:
SUITE 130
Provider Business Practice Location Address City Name:
PULLMAN
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
99163-5512
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
509-332-8843
Provider Business Practice Location Address Fax Number:
509-332-8793
Provider Enumeration Date:
10/11/2005