Provider First Line Business Practice Location Address:
1019 S 40TH AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
YAKIMA
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98908-3877
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
509-966-3880
Provider Business Practice Location Address Fax Number:
509-965-4353
Provider Enumeration Date:
11/21/2005