Provider First Line Business Practice Location Address:
1520 KELLY PLACE, 2ND FLOOR
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:
99362-0329
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
509-524-2920
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
03/08/2011