Provider First Line Business Practice Location Address:
214 E BIRCH ST STE 4
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:
99362-3043
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
503-318-9490
Provider Business Practice Location Address Fax Number:
509-209-9094
Provider Enumeration Date:
02/12/2011