Provider First Line Business Practice Location Address:
214 S 47TH 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:
98908-3234
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
509-965-4502
Provider Business Practice Location Address Fax Number:
866-420-1654
Provider Enumeration Date:
01/10/2007