Provider First Line Business Practice Location Address:
3911 CASTLEVALE RD
Provider Second Line Business Practice Location Address:
SUITE 301
Provider Business Practice Location Address City Name:
YAKIMA
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98902-7807
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
509-453-8231
Provider Business Practice Location Address Fax Number:
509-453-0130
Provider Enumeration Date:
11/20/2006