Provider First Line Business Practice Location Address:
1256 SE BISHOP BOULEVARD
Provider Second Line Business Practice Location Address:
SUITE M
Provider Business Practice Location Address City Name:
PULLMAN
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
99163-2413
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
509-595-5225
Provider Business Practice Location Address Fax Number:
509-334-5515
Provider Enumeration Date:
03/20/2007