Provider First Line Business Practice Location Address:
108 S 4TH AVE # AVE.1826
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:
98902-3428
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
509-965-5310
Provider Business Practice Location Address Fax Number:
509-210-2436
Provider Enumeration Date:
02/20/2007