Provider First Line Business Practice Location Address:
601 MEADOWBROOK RD
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:
98903-9510
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
509-833-9554
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
01/31/2012