Provider First Line Business Practice Location Address:
2505 RACQUET LN
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:
98902-6114
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
509-453-7325
Provider Business Practice Location Address Fax Number:
509-453-7330
Provider Enumeration Date:
06/13/2013