Provider First Line Business Practice Location Address:
1111 W SPRUCE ST STE 30
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:
98902-3264
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
509-631-8363
Provider Business Practice Location Address Fax Number:
509-430-9376
Provider Enumeration Date:
12/06/2023