Provider First Line Business Practice Location Address:
1800 RIVER RD
Provider Second Line Business Practice Location Address:
APT 86
Provider Business Practice Location Address City Name:
YAKIMA
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98902-1263
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
509-930-3548
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
12/04/2012