Provider First Line Business Practice Location Address:
402 S 12TH 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:
98902-3115
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
509-575-0114
Provider Business Practice Location Address Fax Number:
509-575-0808
Provider Enumeration Date:
11/16/2015