Provider First Line Business Practice Location Address:
1105 E. ISAACS STREET
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:
99362-3293
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
509-527-3077
Provider Business Practice Location Address Fax Number:
509-522-4487
Provider Enumeration Date:
01/09/2013