Provider First Line Business Practice Location Address:
406 S 30TH AVE
Provider Second Line Business Practice Location Address:
SUITE 202
Provider Business Practice Location Address City Name:
YAKIMA
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98902-3713
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
509-972-1051
Provider Business Practice Location Address Fax Number:
509-972-4166
Provider Enumeration Date:
09/07/2011