Provider First Line Business Practice Location Address:
1008 S. 38TH AVENUE
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:
98902-0000
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
509-965-1035
Provider Business Practice Location Address Fax Number:
509-965-1580
Provider Enumeration Date:
07/22/2006