Provider First Line Business Practice Location Address:
2200 MELROSE ST STE 7A
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:
99362-1579
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
509-910-9087
Provider Business Practice Location Address Fax Number:
509-631-8695
Provider Enumeration Date:
07/31/2019