Provider First Line Business Practice Location Address:
221 NE A ST
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:
99324-1113
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
509-301-6964
Provider Business Practice Location Address Fax Number:
509-529-5373
Provider Enumeration Date:
02/06/2014