Provider First Line Business Practice Location Address:
204 S COLLEGE AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
COLLEGE PLACE
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
99324-1139
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
509-527-2389
Provider Business Practice Location Address Fax Number:
615-628-4791
Provider Enumeration Date:
09/15/2008