Provider First Line Business Practice Location Address:
215 S 72ND 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:
98908-1629
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
509-480-5082
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
10/24/2012