Provider First Line Business Practice Location Address:
19 E BIRCH ST STE 102
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:
99362-3205
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
509-295-2923
Provider Business Practice Location Address Fax Number:
509-396-5520
Provider Enumeration Date:
09/19/2017