Provider First Line Business Practice Location Address:
252 BRAYTON 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:
99163-8935
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
509-701-4231
Provider Business Practice Location Address Fax Number:
509-483-7169
Provider Enumeration Date:
05/16/2006