Provider First Line Business Practice Location Address:
1020 SE LATAH ST
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:
99163-5408
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
509-254-5053
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
08/04/2025