Provider First Line Business Practice Location Address:
1317 S 24TH AVE # 2
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:
98902-5123
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
509-607-4949
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
06/15/2009