Provider First Line Business Practice Location Address:
7105 W MEAD AVE
Provider Second Line Business Practice Location Address:
UNIT A
Provider Business Practice Location Address City Name:
YAKIMA
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98908-1851
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
970-819-0195
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
06/05/2015