Provider First Line Business Practice Location Address:
2006 W LINCOLN AVE STE A
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
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
509-453-4816
Provider Business Practice Location Address Fax Number:
509-453-4825
Provider Enumeration Date:
02/16/2015