Provider First Line Business Practice Location Address:
16 N 10TH 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:
98902-3015
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
509-594-5002
Provider Business Practice Location Address Fax Number:
509-457-0775
Provider Enumeration Date:
01/29/2007