Provider First Line Business Practice Location Address:
302 E N ST TRLR 38
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:
98901-1845
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
509-307-7031
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
06/11/2008