Provider First Line Business Practice Location Address:
1175 E 8TH 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:
99161-7001
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
509-288-2963
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
04/23/2024