Provider First Line Business Practice Location Address:
6 S 2ND ST SUITE 712
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:
98901-2629
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
509-490-2584
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
03/26/2007