Provider First Line Business Practice Location Address:
302 S 8TH AVE
Provider Second Line Business Practice Location Address:
APT # 2
Provider Business Practice Location Address City Name:
YAKIMA
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98902-3592
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
509-823-5982
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
09/22/2009