Provider First Line Business Practice Location Address:
3907 CREEKSIDE LOOP
Provider Second Line Business Practice Location Address:
SUITE 130
Provider Business Practice Location Address City Name:
YAKIMA
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98902
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
509-225-4555
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
10/16/2007