Provider First Line Business Practice Location Address:
102 N FAIR AVE
Provider Second Line Business Practice Location Address:
STE 102
Provider Business Practice Location Address City Name:
YAKIMA
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98901
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
509-469-0875
Provider Business Practice Location Address Fax Number:
509-469-0865
Provider Enumeration Date:
05/18/2006