Provider First Line Business Practice Location Address:
380 CHASE 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
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
509-522-5895
Provider Business Practice Location Address Fax Number:
509-522-5899
Provider Enumeration Date:
07/26/2006