Provider First Line Business Practice Location Address:
11 N 11TH AVE
Provider Second Line Business Practice Location Address:
#107
Provider Business Practice Location Address City Name:
YAKIMA
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98902
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
509-457-4532
Provider Business Practice Location Address Fax Number:
509-457-0175
Provider Enumeration Date:
10/06/2010