Provider First Line Business Practice Location Address:
103 S 3RD ST
Provider Second Line Business Practice Location Address:
SUITE #204
Provider Business Practice Location Address City Name:
YAKIMA
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98901-2883
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
509-248-1305
Provider Business Practice Location Address Fax Number:
509-574-4250
Provider Enumeration Date:
03/12/2007