Provider First Line Business Practice Location Address:
717 FRUITVALE BLVD
Provider Second Line Business Practice Location Address:
YAKIMA COMMUNITY BASED OUTPT. CLINIC (CBOC)
Provider Business Practice Location Address City Name:
YAKIMA
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98902
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
509-966-0199
Provider Business Practice Location Address Fax Number:
509-966-4266
Provider Enumeration Date:
09/29/2006