Provider First Line Business Practice Location Address:
1750 PORTLAND AVE
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:
99362-2228
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
509-525-2787
Provider Business Practice Location Address Fax Number:
509-525-4183
Provider Enumeration Date:
08/10/2006