Provider First Line Business Practice Location Address:
11 NORTH 11TH AVE.
Provider Second Line Business Practice Location Address:
#104
Provider Business Practice Location Address City Name:
YAKIMA
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98902
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
509-452-7003
Provider Business Practice Location Address Fax Number:
509-452-0428
Provider Enumeration Date:
11/21/2006