Provider First Line Business Practice Location Address:
4601 TIETON DR
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:
98908-3477
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
509-452-2404
Provider Business Practice Location Address Fax Number:
509-452-2409
Provider Enumeration Date:
03/27/2012