Provider First Line Business Practice Location Address:
8 E CHERRY ST
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:
99362-1946
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
509-529-4980
Provider Business Practice Location Address Fax Number:
509-529-4985
Provider Enumeration Date:
04/30/2019