Provider First Line Business Practice Location Address:
622 S 36TH 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:
98902-3943
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
509-966-9592
Provider Business Practice Location Address Fax Number:
509-966-8845
Provider Enumeration Date:
12/13/2006