Provider First Line Business Practice Location Address:
8110 AHTANUM RD
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:
98903-9401
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
509-388-1436
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
08/28/2018