Provider First Line Business Practice Location Address:
6109 W LINCOLN 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:
98908-2764
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
509-307-6619
Provider Business Practice Location Address Fax Number:
509-494-7011
Provider Enumeration Date:
03/23/2007