Provider First Line Business Practice Location Address:
307 SOUTH 11TH 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:
98902-3256
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
509-248-5807
Provider Business Practice Location Address Fax Number:
509-248-5943
Provider Enumeration Date:
10/16/2006