Provider First Line Business Practice Location Address:
1508 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:
98902-4859
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
509-248-0301
Provider Business Practice Location Address Fax Number:
509-248-0337
Provider Enumeration Date:
08/04/2011