Provider First Line Business Practice Location Address:
5203 POSTMA RD
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:
98901-9563
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
509-555-1111
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
07/21/2009