Provider First Line Business Practice Location Address:
1701 CREEKSIDE LOOP STE 106
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:
98902-4874
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
509-910-0329
Provider Business Practice Location Address Fax Number:
509-696-3760
Provider Enumeration Date:
02/20/2012