Provider First Line Business Practice Location Address:
1705 S 24TH 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:
98902-5720
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
509-775-6589
Provider Business Practice Location Address Fax Number:
509-204-3966
Provider Enumeration Date:
10/22/2008