Provider First Line Business Practice Location Address:
104 N 4TH 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:
98902-2636
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
509-573-2045
Provider Business Practice Location Address Fax Number:
509-573-2082
Provider Enumeration Date:
11/08/2012