Provider First Line Business Practice Location Address:
1200 SE 12TH ST STE 4
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:
99324-1827
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
509-529-1481
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
06/20/2006