Provider First Line Business Practice Location Address:
30 W MAIN ST STE 207
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:
509-876-0100
Provider Business Practice Location Address Fax Number:
509-925-2008
Provider Enumeration Date:
08/11/2006