Provider First Line Business Practice Location Address:
212 S 92ND 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:
98908-9361
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
509-972-1051
Provider Business Practice Location Address Fax Number:
509-972-4166
Provider Enumeration Date:
02/04/2008