Provider First Line Business Practice Location Address:
1206 N 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:
98908-9456
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
509-576-6833
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
02/20/2012