Provider First Line Business Practice Location Address:
4003 CREEKSIDE LOOP
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:
98908
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
509-435-2823
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
08/31/2016