Provider First Line Business Practice Location Address:
1260 SE BISHOP BLVD
Provider Second Line Business Practice Location Address:
SUITE B
Provider Business Practice Location Address City Name:
PULLMAN
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
99163-5451
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
509-338-9100
Provider Business Practice Location Address Fax Number:
509-338-0905
Provider Enumeration Date:
12/15/2006