Provider First Line Business Practice Location Address:
112 N 3RD 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:
98902-2630
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
509-457-5346
Provider Business Practice Location Address Fax Number:
509-457-9006
Provider Enumeration Date:
05/09/2011