Provider First Line Business Practice Location Address:
30 W MAIN ST STE 304
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:
99362-2872
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
509-525-8844
Provider Business Practice Location Address Fax Number:
509-525-7755
Provider Enumeration Date:
09/13/2006