Provider First Line Business Practice Location Address:
1805 S 24TH AVE
Provider Second Line Business Practice Location Address:
UNIT A
Provider Business Practice Location Address City Name:
YAKIMA
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98902-6127
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
509-452-1730
Provider Business Practice Location Address Fax Number:
509-574-0757
Provider Enumeration Date:
08/31/2006