Provider First Line Business Practice Location Address:
215 SO 11TH # D
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:
98902
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
509-248-6192
Provider Business Practice Location Address Fax Number:
509-452-5433
Provider Enumeration Date:
12/08/2006