Provider First Line Business Practice Location Address:
1460 N 16TH AVE
Provider Second Line Business Practice Location Address:
SUITE D
Provider Business Practice Location Address City Name:
YAKIMA
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98902-7102
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
509-574-3800
Provider Business Practice Location Address Fax Number:
509-574-3806
Provider Enumeration Date:
08/02/2006