Provider First Line Business Practice Location Address:
120 E BIRCH ST STE 7
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:
877-357-3443
Provider Business Practice Location Address Fax Number:
877-747-3197
Provider Enumeration Date:
01/03/2007