Provider First Line Business Practice Location Address:
409 SOUTH 12TH AVENUE
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:
98902
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
509-575-2949
Provider Business Practice Location Address Fax Number:
509-575-5743
Provider Enumeration Date:
11/02/2010