Provider First Line Business Practice Location Address:
307 S 12TH AVE STE 11
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:
98902-3141
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
509-469-2483
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
01/28/2008