Provider First Line Business Practice Location Address:
5 S 12TH AVE
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:
98902-3106
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
509-248-2020
Provider Business Practice Location Address Fax Number:
509-248-2010
Provider Enumeration Date:
08/22/2005