Provider First Line Business Practice Location Address:
311 N 4TH ST STE 104
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:
98901-2467
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
509-452-8301
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
09/29/2006