Provider First Line Business Practice Location Address:
3909 CREEKSIDE LOOP STE 115
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:
98902-4880
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
509-574-6095
Provider Business Practice Location Address Fax Number:
509-574-6098
Provider Enumeration Date:
08/13/2006