Provider First Line Business Practice Location Address:
419 N 69TH 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:
98908-1280
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
509-966-2757
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
10/13/2006