Provider First Line Business Practice Location Address:
1610 NE EASTGATE BLVD
Provider Second Line Business Practice Location Address:
#850
Provider Business Practice Location Address City Name:
PULLMAN
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
99163-5625
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
509-473-4900
Provider Business Practice Location Address Fax Number:
509-755-4987
Provider Enumeration Date:
07/21/2006