Provider First Line Business Practice Location Address:
2311 ELEANOR ST
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:
98902-2856
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
509-594-0566
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
09/11/2014