Provider First Line Business Practice Location Address:
208 N DIVISION 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:
99362-2323
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
509-529-5377
Provider Business Practice Location Address Fax Number:
509-527-4904
Provider Enumeration Date:
04/09/2007