Provider First Line Business Practice Location Address:
140 NW TRUE ST APT 3
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:
99163-3444
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
509-432-4593
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
03/09/2007