Provider First Line Business Practice Location Address:
206 S 11TH AVE
Provider Second Line Business Practice Location Address:
SUITE 48
Provider Business Practice Location Address City Name:
YAKIMA
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98902-3205
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
509-575-5058
Provider Business Practice Location Address Fax Number:
509-575-5196
Provider Enumeration Date:
07/25/2006