Provider First Line Business Practice Location Address:
1116 S 1ST 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:
98902-4637
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
509-480-0954
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
03/30/2015