Provider First Line Business Practice Location Address:
210 S 72ND AVE
Provider Second Line Business Practice Location Address:
SUITE 130
Provider Business Practice Location Address City Name:
YAKIMA
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98908-1691
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
509-453-3103
Provider Business Practice Location Address Fax Number:
509-453-2057
Provider Enumeration Date:
10/23/2009