Provider First Line Business Practice Location Address:
120 S 72ND AVE
Provider Second Line Business Practice Location Address:
SUITE 102
Provider Business Practice Location Address City Name:
YAKIMA
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98908-4200
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
509-972-1259
Provider Business Practice Location Address Fax Number:
509-972-1258
Provider Enumeration Date:
02/14/2014