Provider First Line Business Practice Location Address:
2612 W NOB HILL BLVD
Provider Second Line Business Practice Location Address:
SUITE 101 # 174
Provider Business Practice Location Address City Name:
YAKIMA
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98902-7503
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
509-901-7420
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
05/13/2007