Provider First Line Business Practice Location Address:
1005 W WALNUT ST STE 101
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:
98902-3384
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
509-454-7780
Provider Business Practice Location Address Fax Number:
509-454-7781
Provider Enumeration Date:
10/10/2018