Provider First Line Business Practice Location Address:
1490 NE NORTH FAIRWAY RD STE C
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:
99163-6077
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
509-590-2602
Provider Business Practice Location Address Fax Number:
509-508-4024
Provider Enumeration Date:
08/20/2025