Provider First Line Business Practice Location Address:
513 N FRONT ST
Provider Second Line Business Practice Location Address:
STE M
Provider Business Practice Location Address City Name:
YAKIMA
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98901-2356
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
509-452-8313
Provider Business Practice Location Address Fax Number:
509-452-8245
Provider Enumeration Date:
12/27/2006