Provider First Line Business Practice Location Address:
2316 EASTGATE ST STE 170
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:
99362-1576
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
509-529-7371
Provider Business Practice Location Address Fax Number:
509-529-7379
Provider Enumeration Date:
04/24/2012