Provider First Line Business Practice Location Address:
314 SO 12TH AVE
Provider Second Line Business Practice Location Address:
SUITE #3
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:
509-453-4504
Provider Business Practice Location Address Fax Number:
509-573-4941
Provider Enumeration Date:
12/11/2006