Provider First Line Business Practice Location Address:
1127 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:
99362-4118
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
509-416-0406
Provider Business Practice Location Address Fax Number:
509-545-1112
Provider Enumeration Date:
08/12/2020