Provider First Line Business Practice Location Address:
214 E BIRCH ST
Provider Second Line Business Practice Location Address:
SUITE 5
Provider Business Practice Location Address City Name:
WALLA WALLA
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
99362-3043
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
509-440-1494
Provider Business Practice Location Address Fax Number:
509-769-0999
Provider Enumeration Date:
05/05/2013