Provider First Line Business Practice Location Address:
1285 SW CENTER ST
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:
99163-5807
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
209-332-2629
Provider Business Practice Location Address Fax Number:
209-332-2749
Provider Enumeration Date:
08/25/2011