Provider First Line Business Practice Location Address:
1205 SE PROFESSIONAL MALL BLVD
Provider Second Line Business Practice Location Address:
SUITE 202
Provider Business Practice Location Address City Name:
PULLMAN
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
99163-5423
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
509-332-8084
Provider Business Practice Location Address Fax Number:
509-332-6380
Provider Enumeration Date:
06/14/2010