Provider First Line Business Practice Location Address:
1815 PORTLAND AVE STE 3
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:
99362-2396
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
503-475-4567
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
03/25/2026