Provider First Line Business Practice Location Address:
1520 KELLY PLACE
Provider Second Line Business Practice Location Address:
2ND FLOOR
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
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
509-527-3278
Provider Business Practice Location Address Fax Number:
509-526-4811
Provider Enumeration Date:
08/10/2006