Provider First Line Business Practice Location Address:
1011 W SPRUCE 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:
98902-3332
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
509-248-6232
Provider Business Practice Location Address Fax Number:
509-575-0192
Provider Enumeration Date:
07/30/2006