Provider First Line Business Practice Location Address:
1205 SE PROFESSIONAL MALL BLVD
Provider Second Line Business Practice Location Address:
SUITE 113
Provider Business Practice Location Address City Name:
PULLMAN
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
99163-5423
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
509-334-0677
Provider Business Practice Location Address Fax Number:
509-334-3115
Provider Enumeration Date:
07/25/2006