Provider First Line Business Practice Location Address:
9312 W WALNUT ST
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:
98908-6802
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
509-930-9577
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
04/25/2024