Provider First Line Business Practice Location Address:
1450 S GRAND AVE
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:
99163-4900
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
509-332-0503
Provider Business Practice Location Address Fax Number:
509-332-0233
Provider Enumeration Date:
06/05/2006