Provider First Line Business Practice Location Address:
301 W POPLAR ST
Provider Second Line Business Practice Location Address:
SUITE 230
Provider Business Practice Location Address City Name:
WALLA WALLA
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
99362-2800
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
509-525-1084
Provider Business Practice Location Address Fax Number:
509-529-7866
Provider Enumeration Date:
04/14/2006