Provider First Line Business Practice Location Address:
1601 S 69TH 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:
98908-5508
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
480-262-1862
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
02/05/2014