Provider First Line Business Practice Location Address:
20 E POPLAR ST STE 206
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:
99362-3099
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
509-527-1156
Provider Business Practice Location Address Fax Number:
509-522-4933
Provider Enumeration Date:
08/31/2011