Provider First Line Business Practice Location Address:
4130 ENGLEWOOD AVE
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:
98908-2634
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
509-571-1640
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
06/16/2023