Provider First Line Business Practice Location Address:
1129 S 2ND AVE STE B
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:
99362-4100
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
509-520-5520
Provider Business Practice Location Address Fax Number:
888-571-1801
Provider Enumeration Date:
06/21/2005