Provider First Line Business Practice Location Address:
821 SELAH CREEK DRIVE
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:
98901-8348
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
509-952-7414
Provider Business Practice Location Address Fax Number:
509-965-1179
Provider Enumeration Date:
05/16/2013