Provider First Line Business Practice Location Address:
4708 COWDEN PL
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:
98908-3737
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
509-833-6587
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
11/04/2009