Provider First Line Business Practice Location Address:
303 S 12TH 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:
98902-3112
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
509-453-8248
Provider Business Practice Location Address Fax Number:
509-248-9012
Provider Enumeration Date:
05/28/2006