Provider First Line Business Practice Location Address:
3902 CREEKSIDE LOOP
Provider Second Line Business Practice Location Address:
100
Provider Business Practice Location Address City Name:
YAKIMA
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98902-4876
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
509-469-1903
Provider Business Practice Location Address Fax Number:
509-469-1905
Provider Enumeration Date:
06/05/2007