Provider First Line Business Practice Location Address:
3411 FRUITVALE BLVD
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:
98902-7320
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
509-972-3989
Provider Business Practice Location Address Fax Number:
509-972-4494
Provider Enumeration Date:
05/10/2006