Provider First Line Business Practice Location Address:
5801 SUMMITVIEW 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:
98908-3006
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
509-965-6393
Provider Business Practice Location Address Fax Number:
509-965-5966
Provider Enumeration Date:
06/07/2006