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:
509-520-9037
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
03/09/2007