Provider First Line Business Practice Location Address:
4001 SUMMITVIEW AVE
Provider Second Line Business Practice Location Address:
SUITE 5-234
Provider Business Practice Location Address City Name:
YAKIMA
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98908-2953
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
509-952-1296
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
01/28/2008