Provider First Line Business Practice Location Address:
1439 DALLES MILITARY RD
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:
99362-9544
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
509-525-1066
Provider Business Practice Location Address Fax Number:
509-522-2361
Provider Enumeration Date:
04/07/2014