Provider First Line Business Practice Location Address:
611 N 39TH 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:
98902-6348
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
509-249-1288
Provider Business Practice Location Address Fax Number:
509-249-6249
Provider Enumeration Date:
08/09/2006