Provider First Line Business Practice Location Address:
1240 SE BISHOP BLVD STE Q
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
PULLMAN
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
99163-5439
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
509-334-0782
Provider Business Practice Location Address Fax Number:
509-334-0361
Provider Enumeration Date:
12/19/2006