Provider First Line Business Practice Location Address:
1015 SO 40TH AVE
Provider Second Line Business Practice Location Address:
SUITE 15
Provider Business Practice Location Address City Name:
YAKIMA
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98908-3867
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
509-966-0660
Provider Business Practice Location Address Fax Number:
509-965-0417
Provider Enumeration Date:
02/12/2007