Provider First Line Business Practice Location Address:
128 N 2ND ST RM B-18
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:
98901-2639
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
509-574-2740
Provider Business Practice Location Address Fax Number:
509-574-2741
Provider Enumeration Date:
07/17/2007