Provider First Line Business Practice Location Address:
513 N FRONT ST STE B
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:
98901-2351
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
509-910-2256
Provider Business Practice Location Address Fax Number:
509-248-9602
Provider Enumeration Date:
04/23/2013