Provider First Line Business Practice Location Address:
301 W POPLAR ST STE 220
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:
99362-2800
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
509-897-8300
Provider Business Practice Location Address Fax Number:
509-897-6066
Provider Enumeration Date:
11/10/2005