Provider First Line Business Practice Location Address:
619A S 48TH AVE
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:
98908-3614
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
509-571-2191
Provider Business Practice Location Address Fax Number:
509-571-2191
Provider Enumeration Date:
03/12/2012