Provider First Line Business Practice Location Address:
4400 DOUGLAS 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:
98908-2691
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
509-573-5883
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
11/30/2012