Provider First Line Business Practice Location Address:
55 W TIETAN ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
WALLA WALLA
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
99362-4498
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
509-525-3720
Provider Business Practice Location Address Fax Number:
509-522-1593
Provider Enumeration Date:
08/01/2005