Provider First Line Business Practice Location Address:
240 SE DEXTER 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:
99163-2331
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
509-332-3144
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
07/21/2022