Provider First Line Business Practice Location Address:
901 SUMMITVIEW AVE
Provider Second Line Business Practice Location Address:
SUITE 210 H
Provider Business Practice Location Address City Name:
YAKIMA
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98902-3062
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
509-453-0964
Provider Business Practice Location Address Fax Number:
509-453-0964
Provider Enumeration Date:
12/10/2007