Provider First Line Business Practice Location Address:
SE 1240 BISHOP BOULEVARD
Provider Second Line Business Practice Location Address:
SUITE P
Provider Business Practice Location Address City Name:
PULLMAN
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
99163
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
509-334-0718
Provider Business Practice Location Address Fax Number:
509-334-0361
Provider Enumeration Date:
11/15/2006