Provider First Line Business Practice Location Address:
705 W ROSE ST STE 1
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:
99362-1762
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
509-529-6036
Provider Business Practice Location Address Fax Number:
509-529-6038
Provider Enumeration Date:
01/25/2007