Provider First Line Business Practice Location Address:
3401 CASTLEVALE RD
Provider Second Line Business Practice Location Address:
APT C
Provider Business Practice Location Address City Name:
YAKIMA
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98902-7400
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
509-688-7598
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
07/21/2009