Provider First Line Business Practice Location Address:
307 S 12TH AVE STE 21
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:
509-972-3905
Provider Business Practice Location Address Fax Number:
509-972-3907
Provider Enumeration Date:
10/02/2006