Provider First Line Business Practice Location Address: 
1001 SUMMITVIEW AVE STE 5
    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: 
98902-3023
    Provider Business Practice Location Address Country Code: 
US
    Provider Business Practice Location Address Telephone Number: 
509-453-0300
    Provider Business Practice Location Address Fax Number: 
509-452-0890
    Provider Enumeration Date: 
08/12/2011