Provider First Line Business Practice Location Address:
299 W TIETAN 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:
99362-4363
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
509-525-2100
Provider Business Practice Location Address Fax Number:
509-522-0313
Provider Enumeration Date:
03/23/2016