Provider First Line Business Practice Location Address:
306 HOLTON AVE
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:
98902-3208
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
509-453-1606
Provider Business Practice Location Address Fax Number:
509-453-5321
Provider Enumeration Date:
05/24/2005