Provider First Line Business Practice Location Address:
321 WELLINGTON AVE
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:
99362-2249
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
509-525-3612
Provider Business Practice Location Address Fax Number:
509-524-8152
Provider Enumeration Date:
06/28/2018