Provider First Line Business Practice Location Address:
307 S 12TH AVE STE 4B
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:
98902-3137
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
509-575-8457
Provider Business Practice Location Address Fax Number:
509-453-1273
Provider Enumeration Date:
06/10/2008