Provider First Line Business Practice Location Address:
1111 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:
98902-3261
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
509-576-7064
Provider Business Practice Location Address Fax Number:
509-576-0679
Provider Enumeration Date:
01/25/2006