Provider First Line Business Practice Location Address:
614 EAST ALDER ST
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:
99362-2073
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
509-529-9660
Provider Business Practice Location Address Fax Number:
509-529-4750
Provider Enumeration Date:
12/18/2008