Provider First Line Business Practice Location Address:
302 W LINCOLN AVE
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:
98902-2656
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
509-248-6726
Provider Business Practice Location Address Fax Number:
509-457-7897
Provider Enumeration Date:
12/13/2010