Provider First Line Business Practice Location Address:
228 W BIRCH 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:
99362-2935
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
509-525-9904
Provider Business Practice Location Address Fax Number:
509-525-9433
Provider Enumeration Date:
10/17/2006