Provider First Line Business Practice Location Address:
3300 ENGLEWOOD 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:
98902-1517
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
509-453-1366
Provider Business Practice Location Address Fax Number:
509-452-4907
Provider Enumeration Date:
11/20/2017