Provider First Line Business Practice Location Address:
420 SE MYRA RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
COLLEGE PLACE
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
99324-1796
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
509-529-4480
Provider Business Practice Location Address Fax Number:
509-529-8776
Provider Enumeration Date:
06/12/2006