Provider First Line Business Practice Location Address:
1423 PLAZA WAY
Provider Second Line Business Practice Location Address:
STE A
Provider Business Practice Location Address City Name:
WALLA WALLA
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
99362-4351
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
509-529-8625
Provider Business Practice Location Address Fax Number:
509-529-8629
Provider Enumeration Date:
11/19/2012