Provider First Line Business Practice Location Address:
307 A 12TH AVE
Provider Second Line Business Practice Location Address:
#16
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:
509-452-1234
Provider Business Practice Location Address Fax Number:
509-249-5831
Provider Enumeration Date:
09/14/2006