Provider First Line Business Practice Location Address:
1607 CREEKSIDE LOOP
Provider Second Line Business Practice Location Address:
SUITE 140
Provider Business Practice Location Address City Name:
YAKIMA
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98902-4882
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
509-969-0243
Provider Business Practice Location Address Fax Number:
509-576-9780
Provider Enumeration Date:
02/16/2010