Provider First Line Business Practice Location Address:
320 N F ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
PALOUSE
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
99161-8713
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
509-432-4082
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
03/19/2025