Provider First Line Business Practice Location Address:
2010 W LINCOLN AVE
Provider Second Line Business Practice Location Address:
SUITE 2
Provider Business Practice Location Address City Name:
YAKIMA
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98902-2413
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
509-972-4422
Provider Business Practice Location Address Fax Number:
509-972-4455
Provider Enumeration Date:
08/24/2006