Provider First Line Business Practice Location Address:
307 S 12TH AVE
Provider Second Line Business Practice Location Address:
SUITE 11
Provider Business Practice Location Address City Name:
YAKIMA
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98902-3100
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
509-910-1844
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
11/08/2011