Provider First Line Business Practice Location Address:
12 N 9TH AVE
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:
98902-3065
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
509-966-4865
Provider Business Practice Location Address Fax Number:
509-452-0342
Provider Enumeration Date:
04/18/2011