Provider First Line Business Practice Location Address:
722 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:
99324-1519
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
509-593-4959
Provider Business Practice Location Address Fax Number:
509-593-4956
Provider Enumeration Date:
12/10/2013