Provider First Line Business Practice Location Address:
56 N COLLEGE AVE UNIT 2
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:
99324-4069
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
509-730-9894
Provider Business Practice Location Address Fax Number:
844-512-2575
Provider Enumeration Date:
10/24/2006