Provider First Line Business Practice Location Address:
118 S 11TH 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:
98902-3204
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
509-307-5699
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
07/18/2018