Provider First Line Business Practice Location Address:
401 E SUMACH ST
Provider Second Line Business Practice Location Address:
#4
Provider Business Practice Location Address City Name:
WALLA WALLA
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
99362-1281
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
509-520-3273
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
04/18/2007