Provider First Line Business Practice Location Address:
1460 DALLES MILITARY ROAD
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
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
509-525-4990
Provider Business Practice Location Address Fax Number:
509-522-0488
Provider Enumeration Date:
03/02/2007