Provider First Line Business Practice Location Address:
107 S 7TH AVE STE 203
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:
98902-3385
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
506-902-2763
Provider Business Practice Location Address Fax Number:
509-453-1453
Provider Enumeration Date:
05/16/2006