Provider First Line Business Practice Location Address:
2222 E ISAACS AVE
Provider Second Line Business Practice Location Address:
APT # E 101
Provider Business Practice Location Address City Name:
WALLA WALLA
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
99362-2212
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
919-600-0436
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
01/26/2011