Provider First Line Business Practice Location Address:
4209 TIETON DR
Provider Second Line Business Practice Location Address:
SUITE 101
Provider Business Practice Location Address City Name:
YAKIMA
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98908-3377
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
509-965-4209
Provider Business Practice Location Address Fax Number:
509-965-5583
Provider Enumeration Date:
07/28/2016