Provider First Line Business Practice Location Address:
411 S 12TH AVE
Provider Second Line Business Practice Location Address:
SUITE 1
Provider Business Practice Location Address City Name:
YAKIMA
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98902-3109
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
509-452-5300
Provider Business Practice Location Address Fax Number:
509-966-4577
Provider Enumeration Date:
01/30/2007