Provider First Line Business Practice Location Address:
205 N 40TH 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:
98908-2949
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
509-966-3031
Provider Business Practice Location Address Fax Number:
509-966-1954
Provider Enumeration Date:
09/29/2011