Provider First Line Business Practice Location Address:
350 CATHERINE 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:
99362-3057
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
509-525-0886
Provider Business Practice Location Address Fax Number:
509-525-9836
Provider Enumeration Date:
03/14/2007