Provider First Line Business Practice Location Address:
2316 EASTGATE ST STE 110
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:
99362-1576
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
509-522-4567
Provider Business Practice Location Address Fax Number:
509-522-4567
Provider Enumeration Date:
06/28/2007