Provider First Line Business Practice Location Address:
314 S 11TH AVE STE A
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:
98902-3212
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
509-902-8585
Provider Business Practice Location Address Fax Number:
509-902-8030
Provider Enumeration Date:
09/30/2017