Provider First Line Business Practice Location Address:
1312 N 16TH 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:
98902-1354
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
509-480-0544
Provider Business Practice Location Address Fax Number:
509-823-4333
Provider Enumeration Date:
10/16/2019