Provider First Line Business Practice Location Address:
1001 W YAKIMA AVE STE 105
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:
98902-3095
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
509-304-9025
Provider Business Practice Location Address Fax Number:
866-480-9279
Provider Enumeration Date:
01/20/2014