Provider First Line Business Practice Location Address:
101 NORTH 4TH AVENUE
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
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
509-573-5064
Provider Business Practice Location Address Fax Number:
509-573-5090
Provider Enumeration Date:
09/06/2006