Provider First Line Business Practice Location Address:
1111 W SPRUCE ST STE 30
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:
98902-3264
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
509-575-1922
Provider Business Practice Location Address Fax Number:
509-248-2501
Provider Enumeration Date:
04/01/2009