Provider First Line Business Practice Location Address:
6 1/2 N 2ND AVE
Provider Second Line Business Practice Location Address:
SUITE 303
Provider Business Practice Location Address City Name:
WALLA WALLA
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
99362-1855
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
509-200-1274
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
08/12/2009