Provider First Line Business Practice Location Address:
1651 W ROSE 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:
99362-1771
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
509-525-9207
Provider Business Practice Location Address Fax Number:
509-529-7061
Provider Enumeration Date:
06/07/2006