Provider First Line Business Practice Location Address:
1129 SOUTH 2ND AVE
Provider Second Line Business Practice Location Address:
SUITE A
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:
509-522-2522
Provider Business Practice Location Address Fax Number:
509-522-0467
Provider Enumeration Date:
10/17/2006