Provider First Line Business Practice Location Address:
1401 S 2ND AVE UNIT B
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:
98902-5620
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
509-426-8461
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
10/11/2021