Provider First Line Business Practice Location Address:
203 W YAKIMA AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SELAH
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98942-1337
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
509-697-4666
Provider Business Practice Location Address Fax Number:
509-697-9575
Provider Enumeration Date:
03/20/2007