Provider First Line Business Practice Location Address:
208 S PARK 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:
99362-3247
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
509-522-0499
Provider Business Practice Location Address Fax Number:
509-522-0593
Provider Enumeration Date:
11/06/2006