Provider First Line Business Practice Location Address:
800 SPRAGUE ST
Provider Second Line Business Practice Location Address:
SUITE 106
Provider Business Practice Location Address City Name:
WALLA WALLA
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
99362-1559
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
509-704-0226
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
06/05/2025