Provider First Line Business Practice Location Address:
1344 UNIVERSITY 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:
99362-2522
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
509-525-1573
Provider Business Practice Location Address Fax Number:
506-529-5295
Provider Enumeration Date:
06/01/2015