Provider First Line Business Practice Location Address:
312 S 8TH AVE APT 14
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:
98902-7602
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
509-930-0689
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
05/06/2021