Provider First Line Business Practice Location Address:
402 S 12TH 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:
98902-3115
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
509-573-3886
Provider Business Practice Location Address Fax Number:
509-225-2715
Provider Enumeration Date:
07/20/2011