Provider First Line Business Practice Location Address:
5951 AIRPORT RD BLDG 1
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:
99163-8958
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
208-882-3571
Provider Business Practice Location Address Fax Number:
208-882-8512
Provider Enumeration Date:
10/10/2023