Provider First Line Business Practice Location Address:
120 E BIRCH ST
Provider Second Line Business Practice Location Address:
SUITE #5
Provider Business Practice Location Address City Name:
WALLA WALLA
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
99362-3054
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
509-525-2923
Provider Business Practice Location Address Fax Number:
509-529-9730
Provider Enumeration Date:
04/11/2008