Provider First Line Business Practice Location Address:
1014 S 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:
98908-3804
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
509-972-8338
Provider Business Practice Location Address Fax Number:
509-972-8356
Provider Enumeration Date:
06/15/2005