Provider First Line Business Practice Location Address:
1624 PLAZA WAY
Provider Second Line Business Practice Location Address:
SUITE 101
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:
509-529-7730
Provider Business Practice Location Address Fax Number:
509-525-9734
Provider Enumeration Date:
01/29/2008