Provider First Line Business Practice Location Address:
314 W MAIN 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:
99362-2821
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
509-524-2650
Provider Business Practice Location Address Fax Number:
509-524-2678
Provider Enumeration Date:
03/15/2007