Provider First Line Business Practice Location Address:
1700 SE MEADOWBROOK BLVD
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:
99324-1798
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
509-525-3700
Provider Business Practice Location Address Fax Number:
509-525-3748
Provider Enumeration Date:
08/29/2006