Provider First Line Business Practice Location Address:
615 S 48TH AVE
Provider Second Line Business Practice Location Address:
SUITE A
Provider Business Practice Location Address City Name:
YAKIMA
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98908-4216
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
509-728-7133
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
06/19/2013