Provider First Line Business Practice Location Address:
609 S 45TH 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:
98908-3336
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
509-571-1155
Provider Business Practice Location Address Fax Number:
509-571-1156
Provider Enumeration Date:
11/29/2018