Provider First Line Business Practice Location Address:
2330 EASTGATE ST STE 207
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:
99362-1559
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
509-876-4009
Provider Business Practice Location Address Fax Number:
509-946-1432
Provider Enumeration Date:
04/16/2015