Provider First Line Business Practice Location Address:
319 S 11TH 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:
98902-3213
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
509-453-1420
Provider Business Practice Location Address Fax Number:
509-453-1453
Provider Enumeration Date:
04/13/2007