Provider First Line Business Practice Location Address:
PO BOX 244
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:
98907-0244
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
509-490-4132
Provider Business Practice Location Address Fax Number:
949-703-8830
Provider Enumeration Date:
01/22/2022