Provider First Line Business Practice Location Address:
1410 SE BISHOP BLVD
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:
99163-5419
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
509-332-2329
Provider Business Practice Location Address Fax Number:
506-334-9239
Provider Enumeration Date:
04/25/2007