Provider First Line Business Practice Location Address:
710 STATE ROUTE 821 UNIT 84
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:
98901-9336
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
509-452-4573
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
12/10/2012