Provider First Line Business Practice Location Address:
450 BRIDGE 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:
99362-3570
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
509-526-1965
Provider Business Practice Location Address Fax Number:
509-529-5842
Provider Enumeration Date:
01/04/2013