Provider First Line Business Practice Location Address:
611 S 44TH 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:
98908-3399
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
509-573-2612
Provider Business Practice Location Address Fax Number:
509-573-2626
Provider Enumeration Date:
10/23/2018