Provider First Line Business Practice Location Address:
349 NE MYRA RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
COLLEGE PLACE
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
99324-9701
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
509-522-4247
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
06/09/2008