Provider First Line Business Practice Location Address:
409 S 12TH 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:
98902-3140
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
818-425-7374
Provider Business Practice Location Address Fax Number:
818-762-0968
Provider Enumeration Date:
05/21/2007