Provider First Line Business Practice Location Address:
3003 TIETON DR
Provider Second Line Business Practice Location Address:
SUITE 230
Provider Business Practice Location Address City Name:
YAKIMA
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98902
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
509-453-7109
Provider Business Practice Location Address Fax Number:
509-453-3659
Provider Enumeration Date:
09/15/2009