Provider First Line Business Practice Location Address:
425 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:
99163-2751
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
509-330-5539
Provider Business Practice Location Address Fax Number:
509-795-0936
Provider Enumeration Date:
06/10/2007