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:
509-494-6719
Provider Business Practice Location Address Fax Number:
509-494-6711
Provider Enumeration Date:
06/12/2007