Provider First Line Business Practice Location Address:
362 S 3RD AVE
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:
99362-3037
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
509-301-6384
Provider Business Practice Location Address Fax Number:
509-593-4789
Provider Enumeration Date:
05/01/2007