Provider First Line Business Practice Location Address:
2117 W LINCOLN AVE STE A
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:
98902-2414
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
509-972-1339
Provider Business Practice Location Address Fax Number:
509-834-2097
Provider Enumeration Date:
11/30/2006