Provider First Line Business Practice Location Address:
210 S 11TH AVE STE 44
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:
98902-3269
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
206-491-0123
Provider Business Practice Location Address Fax Number:
509-895-7344
Provider Enumeration Date:
03/28/2011