Provider First Line Business Practice Location Address:
7 S 10TH 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:
98902-3318
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
509-575-5093
Provider Business Practice Location Address Fax Number:
509-837-6537
Provider Enumeration Date:
08/16/2005