Provider First Line Business Practice Location Address:
1005 W WALNUT ST
Provider Second Line Business Practice Location Address:
STE 102
Provider Business Practice Location Address City Name:
YAKIMA
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98902-3360
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
509-453-8600
Provider Business Practice Location Address Fax Number:
509-453-8616
Provider Enumeration Date:
11/16/2006