Provider First Line Business Practice Location Address:
716 S COLLEGE AVE
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:
99324-1519
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
509-540-2862
Provider Business Practice Location Address Fax Number:
509-527-8838
Provider Enumeration Date:
10/10/2006