Provider First Line Business Practice Location Address:
1025 S 2ND AVE
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:
99362-4116
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
509-525-0480
Provider Business Practice Location Address Fax Number:
509-527-8159
Provider Enumeration Date:
11/30/2005