Provider First Line Business Practice Location Address:
1210 S 72ND AVE
Provider Second Line Business Practice Location Address:
E47
Provider Business Practice Location Address City Name:
YAKIMA
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98908-1994
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
509-380-9618
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
09/12/2008