Provider First Line Business Practice Location Address:
1120 W ROSE ST
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:
99362-1662
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
509-525-6650
Provider Business Practice Location Address Fax Number:
509-522-2349
Provider Enumeration Date:
01/28/2010