Provider First Line Business Practice Location Address:
1806 W LINCOLN 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:
98902-2473
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
509-452-4520
Provider Business Practice Location Address Fax Number:
509-452-5224
Provider Enumeration Date:
09/08/2020