Provider First Line Business Practice Location Address:
30 WEST MAIN ST. #305
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
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
509-240-0135
Provider Business Practice Location Address Fax Number:
509-847-0156
Provider Enumeration Date:
12/07/2013