Provider First Line Business Practice Location Address:
307 S 12TH AVE STE 18
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:
98902-3147
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
509-961-9702
Provider Business Practice Location Address Fax Number:
509-248-3680
Provider Enumeration Date:
03/27/2009