Provider First Line Business Practice Location Address:
5 W ALDER ST STE 316
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:
99362-2863
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
509-240-6621
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
01/24/2012