Provider First Line Business Practice Location Address:
1006 S 50TH 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:
98908-3716
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
509-895-6025
Provider Business Practice Location Address Fax Number:
509-424-3421
Provider Enumeration Date:
12/14/2012