Provider First Line Business Practice Location Address:
17 N 3RD ST
Provider Second Line Business Practice Location Address:
SUITE 301
Provider Business Practice Location Address City Name:
YAKIMA
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98901-2709
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
509-941-8540
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
03/16/2007