Provider First Line Business Practice Location Address:
1806 W LINCOLN 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:
98902-2473
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
509-452-4946
Provider Business Practice Location Address Fax Number:
509-457-3989
Provider Enumeration Date:
06/07/2011