Provider First Line Business Practice Location Address:
314 S 11TH AVE
Provider Second Line Business Practice Location Address:
SUITE A
Provider Business Practice Location Address City Name:
YAKIMA
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98902-3212
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
509-575-0114
Provider Business Practice Location Address Fax Number:
509-575-0808
Provider Enumeration Date:
05/23/2008