Provider First Line Business Practice Location Address:
1125 NE WASHINGTON ST
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:
99164-2302
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
509-335-7492
Provider Business Practice Location Address Fax Number:
509-335-2092
Provider Enumeration Date:
01/23/2007