Provider First Line Business Practice Location Address:
1213 S 40TH AVE
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:
98908-3961
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
509-966-8981
Provider Business Practice Location Address Fax Number:
509-966-2125
Provider Enumeration Date:
08/16/2005