Provider First Line Business Practice Location Address:
1214 W LINCOLN AVE STE A
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:
98902-2576
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
509-453-1702
Provider Business Practice Location Address Fax Number:
509-453-1703
Provider Enumeration Date:
05/01/2012