Provider First Line Business Practice Location Address:
1112 W SPRUCE ST
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:
98902-3210
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
509-453-4835
Provider Business Practice Location Address Fax Number:
509-453-7691
Provider Enumeration Date:
09/12/2006