Provider First Line Business Practice Location Address:
120 E BIRCH ST STE 9
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:
99362-3054
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
509-527-8451
Provider Business Practice Location Address Fax Number:
509-527-0942
Provider Enumeration Date:
03/27/2008