Provider First Line Business Practice Location Address:
1017 S 2ND AVE
Provider Second Line Business Practice Location Address:
SUITE 2
Provider Business Practice Location Address City Name:
WALLA WALLA
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
99362-4183
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
509-522-0606
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
01/13/2006