Provider First Line Business Practice Location Address:
600 SUPERIOR LN
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:
98902-1623
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
509-853-4154
Provider Business Practice Location Address Fax Number:
509-576-3050
Provider Enumeration Date:
10/29/2018