Provider First Line Business Practice Location Address:
915 NE VALLEY RD
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:
99163-3845
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
509-332-3548
Provider Business Practice Location Address Fax Number:
509-332-5253
Provider Enumeration Date:
02/21/2007