Provider First Line Business Practice Location Address:
115 NW STATE STREET
Provider Second Line Business Practice Location Address:
SUITE 106
Provider Business Practice Location Address City Name:
PULLMAN
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
99163-2616
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
509-332-4420
Provider Business Practice Location Address Fax Number:
509-339-2399
Provider Enumeration Date:
12/19/2007