Provider First Line Business Practice Location Address:
1600 E CHESTNUT 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:
98901-2174
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
509-576-3989
Provider Business Practice Location Address Fax Number:
509-576-4375
Provider Enumeration Date:
11/18/2011