Provider First Line Business Practice Location Address:
1608 S 24TH AVE STE 102
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:
98902-5719
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
509-248-6113
Provider Business Practice Location Address Fax Number:
509-457-8941
Provider Enumeration Date:
01/23/2006