Provider First Line Business Practice Location Address:
1125 SE WASHINGTON
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:
99164-2302
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
509-335-3575
Provider Business Practice Location Address Fax Number:
509-335-8214
Provider Enumeration Date:
12/04/2006