Provider First Line Business Practice Location Address:
5301 TIETON DR
Provider Second Line Business Practice Location Address:
SUITE C, C/O HOPE CENTER
Provider Business Practice Location Address City Name:
YAKIMA
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98908-3479
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
509-965-7100
Provider Business Practice Location Address Fax Number:
509-966-9750
Provider Enumeration Date:
07/20/2015