Provider First Line Business Practice Location Address:
1230 NE HICKMAN COURT
Provider Second Line Business Practice Location Address:
SUITE 2
Provider Business Practice Location Address City Name:
PULLMAN
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
99163
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
509-332-4149
Provider Business Practice Location Address Fax Number:
509-332-1872
Provider Enumeration Date:
09/25/2006