Provider First Line Business Practice Location Address:
800 SPRAGUE AVE
Provider Second Line Business Practice Location Address:
SUITE #104
Provider Business Practice Location Address City Name:
WALLA WALLA
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
99362-3900
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
509-540-7211
Provider Business Practice Location Address Fax Number:
888-972-3661
Provider Enumeration Date:
04/23/2007