Provider First Line Business Practice Location Address:
2215 S 67TH 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:
98903-9478
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
503-396-7856
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
08/13/2018