Provider First Line Business Practice Location Address:
614 E ALDER ST
Provider Second Line Business Practice Location Address:
SUITE 2
Provider Business Practice Location Address City Name:
WALLA WALLA
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
99362-2073
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
509-522-0790
Provider Business Practice Location Address Fax Number:
509-529-1094
Provider Enumeration Date:
03/08/2007