Provider First Line Business Practice Location Address:
112 S 39TH ST
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:
98901-1450
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
509-248-4957
Provider Business Practice Location Address Fax Number:
509-575-5436
Provider Enumeration Date:
07/30/2006