Provider First Line Business Practice Location Address:
3907 CREEKSIDE LOOP
Provider Second Line Business Practice Location Address:
SUITE 110
Provider Business Practice Location Address City Name:
YAKIMA
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98902-4879
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
509-469-5515
Provider Business Practice Location Address Fax Number:
509-469-5517
Provider Enumeration Date:
11/16/2007