Provider First Line Business Practice Location Address:
1205 SE PROFESSIONAL MALL BLVD
Provider Second Line Business Practice Location Address:
SUITE #108
Provider Business Practice Location Address City Name:
PULLMAN
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
99163-5423
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
509-332-6015
Provider Business Practice Location Address Fax Number:
509-332-4312
Provider Enumeration Date:
10/13/2006