Provider First Line Business Practice Location Address:
YAKIMA CBOC
Provider Second Line Business Practice Location Address:
717 FRUITVALE BLVD
Provider Business Practice Location Address City Name:
YAKIMA
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98908
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
509-966-0199
Provider Business Practice Location Address Fax Number:
509-966-4266
Provider Enumeration Date:
10/02/2006