Provider First Line Business Practice Location Address:
208 S 72ND AVE
Provider Second Line Business Practice Location Address:
STE 100
Provider Business Practice Location Address City Name:
YAKIMA
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98908-1600
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
509-576-4292
Provider Business Practice Location Address Fax Number:
509-966-3303
Provider Enumeration Date:
10/20/2005