Provider First Line Business Practice Location Address:
1006 S 64TH AVE
Provider Second Line Business Practice Location Address:
STE 120
Provider Business Practice Location Address City Name:
YAKIMA
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98908-2090
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
509-517-5777
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
04/25/2017