Provider First Line Business Practice Location Address:
1718 S 10TH AVE APT B
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:
98902-5879
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
509-594-6774
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
06/21/2023