Provider First Line Business Practice Location Address:
1212 S 43RD AVE APT B
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:
98908-3991
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
509-949-8790
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
08/27/2010