Provider First Line Business Practice Location Address:
860 S 2ND AVE STE A
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:
99362-4072
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
509-529-2000
Provider Business Practice Location Address Fax Number:
509-529-4590
Provider Enumeration Date:
06/03/2011