Provider First Line Business Practice Location Address:
2402 S 1ST ST
Provider Second Line Business Practice Location Address:
SUITE 112
Provider Business Practice Location Address City Name:
YAKIMA
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98903-1646
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
509-972-7594
Provider Business Practice Location Address Fax Number:
509-972-7599
Provider Enumeration Date:
12/10/2014