Provider First Line Business Practice Location Address:
702 S 72ND AVE APT A
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:
98908-1823
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
509-654-3204
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
04/23/2008