Provider First Line Business Practice Location Address:
55 W WASHINGTON AVE UNIT 165
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:
98903-2258
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
509-426-2622
Provider Business Practice Location Address Fax Number:
509-426-2616
Provider Enumeration Date:
11/08/2013