Provider First Line Business Practice Location Address:
719 N 39TH AVE
Provider Second Line Business Practice Location Address:
SUITE 102
Provider Business Practice Location Address City Name:
YAKIMA
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98902-6302
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
509-453-3350
Provider Business Practice Location Address Fax Number:
509-453-3360
Provider Enumeration Date:
12/27/2006