Provider First Line Business Practice Location Address:
3999 ENGLEWOOD AVE
Provider Second Line Business Practice Location Address:
SUITE 202
Provider Business Practice Location Address City Name:
YAKIMA
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98902-6334
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
509-453-4614
Provider Business Practice Location Address Fax Number:
509-453-3468
Provider Enumeration Date:
07/27/2006