Provider First Line Business Practice Location Address:
218 N 78TH 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:
98908-1301
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
574-238-1818
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
10/01/2010