Provider First Line Business Practice Location Address:
2330 EASTGATE ST, NORTH
Provider Second Line Business Practice Location Address:
STE 205
Provider Business Practice Location Address City Name:
WALLA WALLA
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
99362-2557
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
509-301-7252
Provider Business Practice Location Address Fax Number:
509-522-2330
Provider Enumeration Date:
11/16/2006