Provider First Line Business Practice Location Address:
121 W POPLAR STREET
Provider Second Line Business Practice Location Address:
SUITE A
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:
509-525-3522
Provider Business Practice Location Address Fax Number:
509-525-0518
Provider Enumeration Date:
08/18/2006