Provider First Line Business Practice Location Address:
4 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:
99362-2816
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
509-525-1010
Provider Business Practice Location Address Fax Number:
509-525-8341
Provider Enumeration Date:
10/24/2006