Provider First Line Business Practice Location Address:
380 CHASE AVENUE
Provider Second Line Business Practice Location Address:
PMG SE WA
Provider Business Practice Location Address City Name:
WALLA WALLA
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
99362-2924
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
509-526-3333
Provider Business Practice Location Address Fax Number:
509-526-8402
Provider Enumeration Date:
10/10/2008