Provider First Line Business Practice Location Address:
210 S 11TH AVE
Provider Second Line Business Practice Location Address:
SUITE #45
Provider Business Practice Location Address City Name:
YAKIMA
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98902-3293
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
509-454-2273
Provider Business Practice Location Address Fax Number:
509-454-7901
Provider Enumeration Date:
12/28/2006