Provider First Line Business Practice Location Address:
315 E MAIN ST STE A
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:
99362-2003
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
509-525-8844
Provider Business Practice Location Address Fax Number:
509-525-7755
Provider Enumeration Date:
09/13/2006