Provider First Line Business Practice Location Address:
6513 W CHESTNUT AVE
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:
98908-1746
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
509-833-6373
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
12/21/2012