Provider First Line Business Practice Location Address:
1111 W SPRUCE ST
Provider Second Line Business Practice Location Address:
STE 22
Provider Business Practice Location Address City Name:
YAKIMA
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98902-3257
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
509-248-6414
Provider Business Practice Location Address Fax Number:
509-902-1099
Provider Enumeration Date:
03/14/2006